An Economic Analysis of Financial Barriers to Access Comprehensive Gender Confirmation Surgery

With the increase in insurance coverage and social acceptance in the USA there has been an increase is transgender patients seeking gender confirming procedures from plastic surgeons. The purpose of this study is to compare the estimated cost for genital reconstruction with vaginoplasty vs. phalloplasty in the transgender patient. Given the drastic differences in these procedures we primarily hypothesize that the cost of female to male transformation will be significantly higher when compared to male to female transformation due to the complexity of neophallus creation, and extended hospital stay due to free flap. The aim of this study is to review available cost estimates publically available and at our institution for cost analysis.

A comprehensive literature search of PUBMED for associated cost of vaginoplasty and phalloplasty in the transgender patients was conducted as well as Internet browser search for any private practice surgical pricing. Our academic professional fees were readily available from the billing department. Facility fees were estimated based on average lengths of gender conformation surgeries and duration of convalescence. One surgery center was found to have posted pricing for vaginoplasty and phalloplasty on their website which was included in analysis.

When comparing genital reconstruction total estimated cost in the transgender community, neophallus formation costs more than neovagina formation with a difference of $17,152.00 (35.4%increase) at our institution and mirrored in the private practice surgery center with a difference of $1,500.00 (7.6% increase). This discrepancy in cost may lead to financial barriers to access comprehensive gender affirming surgery.