Mean day/contacts, costs and excess healthcare costs of gender incongruence and gender dysphoria (6 months, in €, 2020)
| Cost category | TGD people with GIC/GD (n=167) | People from the general population (n=2811) | Excess costs in € (SE)† | 95% CI | P value | ||
| Mean days/contacts (SE) | Mean costs in € (SE) | Mean days/contacts (SE) | Mean costs in € (SE) | ||||
| Hospital/day care/rehabilitation | 3.66 (1.08) | 1262 (388) | 1.97 (0.85) | 835 (319) | 427 (502) | −558 to 1412 | 0.395 |
| Psychiatric hospital/day care | 1.95 (0.77) | 597 (243) | 0.97 (0.45) | 292 (131) | 305 (277) | −236 to 848 | 0.269 |
| Somatic hospital/day care/rehabilitation | 1.72 (0.79) | 665 (310) | 1.00 (0.34) | 544 (182) | 121 (360) | −585 to 827 | 0.737 |
| Outpatient medical services | 8.68 (0.81) | 412 (51) | 8.87 (0.79) | 392 (47) | 20 (70) | −117 to 156 | 0.781 |
| Psychiatric medical services | 3.30 (0.57) | 249 (46) | 2.19 (0.53) | 162 (39) | 87 (60) | −30 to 206 | 0.145 |
| Somatic medical services | 5.38 (0.47) | 162 (14) | 6.68 (0.45)* | 230 (18) | −68 (23) | −113 to −24 | 0.003 |
| Outpatient non-medical services | 1.69 (0.47) | 49 (15) | 3.01 (0.55) | 72 (15) | −23 (21) | −64 to 18 | 0.275 |
| Nursing care | 4.75 (2.10)* | 100 (43) | 25.66 (8.77)* | 522 (178) | −422 (183) | −787 to −69 | 0.020 |
| Formal nursing care | 0.26 (0.15) | 9 (4) | 0.11 (0.09) | 3 (4) | 6 (5) | −3 to 16 | 0.189 |
| Informal nursing care | 4.49 (2.09)* | 91 (42) | 25.55 (8.77)* | 519 (178) | −428 (183) | −781 to −62 | 0.021 |
| Absenteeism/unemployment | 57.13 (4.85) | 16 951 (1420) | 53.98 (4.13) | 16 282 (1244) | 669 (1888) | −3031 to 4370 | 0.723 |
| Absenteeism | 6.53 (1.40)* | 1690 (369) | 3.43 (0.57)* | 1033 (173) | 657 (407) | −141 to 1456 | 0.107 |
| Unemployment | 50.60 (4.91) | 15 261 (1480) | 50.56 (4.41) | 15 249 (1329) | 12 (1989) | −3886 to 3911 | 0.995 |
| Total healthcare costs | – | 1824 (402) | – | 1822 (403) | 2 (570) | −1115 to 1119 | 0.997 |
| Total costs (plus indirect costs) | – | 18 775 (1547) | – | 18 103 (1320) | 672 (2034) | −3315 to 4657 | 0.741 |
*p<0.05.
†Excess healthcare costs were calculated by a weighted two-part model with logit specification for the first part and a generalised linear model with gamma family and log link function for the second part with robust SEs. Weights were derived from the entropy balancing model that included the covariates age, sex assigned at birth, marital status, school-leaving qualification, professional education and morbidities according to the chapters II, IV, V, and IX–XIII of the ICD-10.
GD, gender dysphoria; GIC, gender incongruence; ICD-10, International Statistical Classification of Diseases and Related Health Problems 10th Revision; TGD, transgender and gender diverse.