SP12. Providing Gender Affirming Care In A Public Health Payer System: Health Policy Implications From A Cost-utility Analysis Of Top Surgery
Notice bibliographique
Résumé
Purpose: Gender affirming surgery can have significant positive clinical impacts by improving mental and physical health for transgender and gender diverse (TGD) individuals desiring surgery. Top surgery (i.e., chest reconstructive mastectomy or augmentation) is a safe and commonly performed surgery for TGD individuals. While a previous study has conducted economic evaluations of gender affirming care from the perspective of a United States insurance provider, focused examination of the cost and utility impacts of gender affirming surgical care have yet to be appraised in a publicly funded healthcare system. This study aimed to examine these impacts in a Canadian healthcare system contextualized with potential health policy implications. Methods: A cost-utility analysis (CUA) was conducted. The CUA examined incremental cost per quality adjusted life year (QALY), a standardized measure of patient intervention impact, gained through the provision of gender affirming top surgery. A Markov model was used to estimate the health care costs and QALYs gained from top surgery compared to no surgery. Sub-groups with and without hormone therapy were included to represent current estimates of TGD patients’ hormone use. A cohort of 1000 prospective adult TGD patients were used to represent current surgical waitlist estimates. Once they entered the model, patients experienced outcomes over one-year cycles for ten cycles. A half cycle correction was applied to the model. Given provincial funding differences, the analysis used the Ontario public payer perspective with costs reported in 2022 Canadian dollars. Costs, QALYs, and probability states were derived from health authority reports and the literature. A probabilistic sensitivity analysis was conducted to assess robustness of results, applying standard distributions to each variable in the model and running 10,000 Monte Carlo simulations. Results: Top surgery is considered cost-effective compared to no surgery over a ten-year time horizon when considering the impacts of mental health, suicidal ideation, and smoking, using a typical willingness to pay threshold of $50,000/QALY. The ten-year incremental cost effectiveness ratio, measuring intervention costs per QALY, was $-81,183.56 per QALY gained, with a net monetary benefit of $394,050.00. Results were robust with 97.5% of the Monte Carlo simulations finding surgical intervention cost effective in the probabilistic sensitivity analysis. Further top surgery was dominant in 75.4% of these simulations. Conclusions: Economic evaluation findings suggest that when mental and physical health benefits are considered, top surgery is cost-effective when compared to no surgery for adult TGD individuals in Ontario. Considering these additional patient health states can more accurately assess system level impacts of gender affirming surgical care provision. By using a cohort size representative of the current surgical waitlist numbers, these findings suggest there may be system level benefit to prioritizing providing access to care for waitlisted patients. Further research may include evaluation of other provincial health systems and incorporation of patient lived experience to identify outcomes not routinely accounted for in current economic evaluation models.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,002 | 0,005 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».