Grochtdreis Thomas, König Hans-Helmut, Renner Janis, Sehner Susanne, Dekker Arne, Briken Peer, Nieder Timo O, Dams Judith
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20251, Germany, 49 40741053382, 49 40741040261.
Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Med Internet Res. 2025 Jun 19;27:e66371. doi: 10.2196/66371.
The provision of specialized, professionally coordinated, and interdisciplinary care is relevant for the care of transgender and gender diverse (TGD) people diagnosed with gender incongruence or gender dysphoria. In remote areas outside the metropolitan regions, however, transgender health care structures are rarely adequate or within reach. In order to improve transgender health care for TGD people, an interdisciplinary, internet-based transgender health care program (i²TransHealth) has been developed.
The aim of this study was to determine the cost-effectiveness of i²TransHealth for TGD people from remote areas with no or insufficient transgender health care structures either exploring their gender identity or being in an early phase of transition from a societal perspective.
This study was conducted alongside a randomized controlled trial comparing the effectiveness of i²TransHealth with a waiting list. The i²TransHealth intervention consisted of a telehealth-based eHealth intervention including one-to-one chat conversations with study therapists in combination with office-based regular care provided by general physicians and psychiatrists when needed. As health effect measures, quality-adjusted life years (QALYs) were calculated based on the EuroQol 5-dimension 5-level index, and reliable improvement on the Global Severity Index of the Brief Symptom Inventory-18 (BSI-18 GSI) was used. Health care service usage was assessed using service receipt inventories. The cost-effectiveness of i²TransHealth compared with a waiting list was assessed using the adjusted incremental cost-effectiveness ratio (ICER) based on seemingly unrelated regressions. Furthermore, the uncertainty of the ICER was assessed using cost-effectiveness planes and cost-effectiveness acceptability curves.
Participants in the intervention group (IG; n=88) and the control group (CG; n=80) were on average aged 26 and 27 years, respectively. The mean QALYs of participants in the IG and CG were both 0.28 (SE 0.00) during the 4-month follow-up period. With 23.02%, participants in the IG had statistically significantly higher reliable improvement on the BSI-18 GSI compared with participants in the CG (9.21%, P=.01). The mean 4-month total costs were statistically significantly higher among the participants in the IG (+€1390, P=.002; a currency exchange rate of €1=US $1.14 was applicable as of December 31, 2020). The corresponding ICER of i²TransHealth was €254,021 per additional QALY, and €10,786 per additional reliable improvement on the BSI-18 GSI, respectively. The corresponding probability of cost-effectiveness of i²TransHealth was 20% at a willingness-to-pay (WTP) of €150,000 per additional QALY and 75% at a WTP of €15,000 per additional reliable improvement on the BSI-18 GSI.
From a societal perspective, i²TransHealth was unlikely to be cost-effective, even at high WTP per additional QALY. However, the comparison of i²TransHealth with a waiting list could have led to a distortion of the results with regard to health care service usage. When considering additional reliable improvement on the BSI-18 GSI as health effect measure, the probability of cost-effectiveness of i²TransHealth is unclear depending on the WTP.
为被诊断患有性别不一致或性别焦虑症的跨性别者和性别多样化（TGD）人群提供专业、专业协调的跨学科护理具有重要意义。然而，在大都市地区以外的偏远地区，跨性别者医疗保健结构很少足够或难以获得。为了改善针对TGD人群的跨性别者医疗保健，已开发了一个基于互联网的跨学科跨性别者医疗保健项目（i²TransHealth）。
本研究的目的是从社会角度确定i²TransHealth对于来自没有或缺乏跨性别者医疗保健结构的偏远地区、正在探索其性别认同或处于转型早期阶段的TGD人群的成本效益。
本研究与一项随机对照试验同时进行，该试验比较了i²TransHealth与等待名单的有效性。i²TransHealth干预包括基于远程医疗的电子健康干预，包括与研究治疗师进行一对一的聊天对话，并在需要时由普通医生和精神科医生提供基于办公室的常规护理。作为健康效果指标，基于欧洲五维五级指数计算质量调整生命年（QALY），并使用简明症状量表18（BSI-18）全球严重程度指数的可靠改善情况。使用服务接受清单评估医疗服务使用情况。使用基于看似不相关回归的调整增量成本效益比（ICER）评估i²TransHealth与等待名单相比的成本效益。此外，使用成本效益平面和成本效益可接受性曲线评估ICER的不确定性。
干预组（IG；n = 88）和对照组（CG；n = 80）的参与者平均年龄分别为26岁和27岁。在4个月的随访期内，IG组和CG组参与者的平均QALY均为0.28（标准误0.00）。与CG组参与者（9.21%）相比，IG组参与者在BSI-18 GSI上的可靠改善在统计学上显著更高（23.02%，P = 0.01）。IG组参与者4个月的平均总成本在统计学上显著更高（增加1390欧元，P = 0.002；截至2020年12月31日，适用的货币汇率为1欧元 = 1.14美元）。i²TransHealth的相应ICER分别为每增加一个QALY 254,021欧元，以及每在BSI-18 GSI上增加一次可靠改善10,786欧元。在每增加一个QALY的支付意愿（WTP）为150,000欧元时，i²TransHealth成本效益的相应概率为20%，在每在BSI-18 GSI上增加一次可靠改善的WTP为15,000欧元时，概率为75%。
从社会角度来看，即使在每增加一个QALY的高WTP情况下，i²TransHealth也不太可能具有成本效益。然而，将i²TransHealth与等待名单进行比较可能导致在医疗服务使用方面的结果失真。当将BSI-18 GSI上的额外可靠改善作为健康效果指标时，i²TransHealth成本效益的概率根据WTP尚不清楚。
