D96. The Cost-effectiveness of Gender-affirming Mastectomy

Abstract

PURPOSE: Although gender affirming surgery (GAS) is associated with positive physical and mental health for transgender individuals, limited surgical resources and lack of insurance coverage remain impactful barriers to GAS. The objective of this study was to demonstrate the cost-effectiveness of gender-affirming mastectomy. METHODS: A cost-effectiveness analysis was performed using a Markov model with a willingness to pay (WTP) threshold of $100,000/Quality Adjusted Life Year (QALY). The two main arms of the Markov model were access to top surgery or lack thereof with additional sub-arms of negative or positive health events. Data on health event probability, quality of life, and cost were extracted from the 2015 US Trans Survey (USTS), the Froedtert & Medical College of Wisconsin Health Network, and available literature. RESULTS: Compared to lack of access ($7,192.64, 0.69 QALY’s), gender-affirming mastectomy results in a greater annual cost and effectiveness ($10,661.07, 0.85 QALY’s) with an incremental cost-effectiveness ratio (ICER) of $21,876.52/QALY within the first year. For patients with access to surgical care, lack of access to gender affirming hormone therapy (GAHT) came at a greater cost and worse effectiveness compared to access to GAHT with a ICER of -$122.34/QALY. CONCLUSION: We are one of the first groups utilizing the 2015 USTS to establish gender-affirming mastectomy and GAHT for transgender patients is cost-effective as demonstrated by an ICER less than the WTP threshold. These findings suggest hormonal and surgical gender affirming care should be provided by health institutions and covered by insurance.