Cost-Effectiveness of an Interdisciplinary, Internet-Based Transgender Health Care Program in Germany: Economic...

Area of Science:

• Health Services Research
• Digital Health
• Transgender Health

Background:

• Specialized care is crucial for transgender and gender diverse (TGD) individuals with gender incongruence or dysphoria.
• Transgender healthcare structures are often inadequate or inaccessible in remote areas.
• The i²TransHealth program was developed to address these gaps through an interdisciplinary, internet-based approach.

Purpose of the Study:

• To determine the cost-effectiveness of the i²TransHealth program for TGD individuals in remote areas.
• To evaluate i²TransHealth for those exploring gender identity or in early transition phases.

Main Methods:

• A randomized controlled trial compared i²TransHealth to a waiting list.
• The intervention included telehealth, e-health, and general practitioner/psychiatrist care.
• Health outcomes measured quality-adjusted life years (QALYs) and reliable improvement on the Brief Symptom Inventory-18 Global Severity Index (BSI-18 GSI).

Main Results:

• No significant difference in QALYs was observed between the intervention and control groups.
• The intervention group showed significantly higher reliable improvement on the BSI-18 GSI (23.02% vs. 9.21%).
• Total costs were significantly higher in the intervention group (+€1390), with an ICER of €254,021 per QALY and €10,786 per BSI-18 GSI improvement.

Conclusions:

• i²TransHealth is unlikely to be cost-effective from a societal perspective when measured by QALYs.
• Cost-effectiveness is unclear when using BSI-18 GSI improvement as the primary outcome, depending on willingness-to-pay.
• Potential distortions in health care service usage data require consideration.