The South and West Development and Evaluation Serv

1、SurgicalgenderreassignmentformaletofemaletranssexualpeopleSeptember1998ThisreporthasbeenpreparedaspartoftheDevelopmentandEvaluationServicefundedbytheResearchandDevelopmentDirectorateSouthandWest.Itisintendedtoproviderapid,accurateandusableinformationonhealthtechnologyeffectivenesstopurchasers,clinicians,managersandresearchersintheSouthandWest.Thisreportmaybephotocopied.ThefulltextisavailableontheInternet:://ww.soton.ac.uk/~dec/DECevelopment&valuationommitteeReportNo.88TheSouthandWestDevelopment。

2、andEvaluationServicePurposeTheDevelopmentandEvaluationServiceisfundedbytheResearchandDevelopmentDirectorateoftheNHSExecutive(SouthandWestRegionalOffice)toproviderapid,accurateandusableinformationonthecosteffectivenessofhealthtechnologiesinresponsetotheneedsofNHScommissionersandproviders.TheserviceTheservicehastwoelements:astructuredreview,typicallypreparedinthreetosixmonths,andtheDevelopmentandEvaluationCommittee(DEC)madeupofseniorcliniciansandotherindependentindividualswhichmeetsquarterly.TheDE。

3、Cconsidersthequalityofavailableevidenceandthelikelyvalueformoneyofferedbytheinterventionpresentedinthereport,andreachesajustifiedconclusiononthesupportitgivestheintervention.MethodsDECreportsareinformedbyonlineliteraturesearch,areviewofbibliographiesandreferencelistsandconsultationwithclinicalexperts.Evidenceissoughtontheeffectivenessofinterventions,theircostandtheepidemiologyofthehealthproblemconcerned.Appraisalofevidenceforeffectivenessisguidedbystandardchecklists(particularlythosedevelopedfor。

4、theCriticalAppraisalSkillsProgramme).Detailedandfullyaccuratecostinformationisoftennotavailable.Extracontractualreferraltariffsandotherlessprecisecostestimatesareusedwhentheyaretheonlysourceofcostingstotherequiredlevelofdetail.Theresultsofrelevantstudiesarepresentedindividuallyandthemostplausibleresultsusedinfurtheranalysis.TheIndexofHealthRelatedQualityofLifeisusedtoestimatebenefitsasQualityAdjustedLifeYears(QALYs)wherepossible.QALYestimatesarecombinedwithcostdatatoprovideanestimateofcostutilit。

5、y,allowingcomparisonofthevalueformoneyoftheinterventioninprovidinghealthgain.Uncertaintiesinestimatesofcostsandbenefits(andthereforethevalueformoneyassociatedwithimplementationoftheinterventionconcerned)areexploredinsensitivityanalyses.TheconclusionsoftheDECfallintooneoffivepredefinedcategories:StronglysupportedSupportedLimitedsupportNotsupportedNotprovenReportsarecirculatedwidelythroughouttheSouthandWestRegionbytheNHSExecutiveandarepublishedinfullontheDECinternetsite:~dec/InterDECTheWessexInsti。

6、tuteforHealthResearchandDevelopmenthasnowjoinedawidercollaborationwiththreeunitsinotherRegions(theTrentWorkingGrouponAcutePurchasing,theScottishHealthPurchasingInformationCentreandtheUniversityofBirminghamInstituteforPublicEnvironmentalHealth)tosharetheworkonreviewingtheeffectivenessandcost-effectivenessofclinicalinterventions.Thisgroup,InterDEC,willsharework,avoidduplicationandimprovethepeerreviewingandqualitycontrolofthesereports.ThisreportwaspreparedbasedonliteratureavailableuptoApril1988byLe。

7、sleyBest,KenSteinSeriesEditors:DrRuairidhMilneandDrKenSteinWessexInstituteforHealthResearchandDevelopmentReporttotheDevelopmentandEvaluationCommitteesNo.88sSeptember1998Surgicalgenderreassignmentformaletofemaletranssexualpeople1SURGICALGENDERREASSIGNMENTFORMALETOFEMALETRANSSEXUALPEOPLEConclusionoftheDevelopmentandEvaluationCommitteeConclusion:NotprovenCommentary:Itisclearthatasmallnumberofpeoplemayexperienceimportantbenefitsfromthistechnology.However,thepotentialhazardsoftreatmentareconsiderable。

8、andmorerigorousresearchisrequiredintothelongtermrisksandbenefitstosupportcaseselectionandjustifyservicedevelopment.Wheresurgeryisperformeditshouldberestrictedtospecialistcentreswithproventechnicalexpertiseandwhichhaveclearprotocolsforpatientselectionandgoodclinicalauditinplace.Pendingimprovementstotheevidencebaseinthisarea,theCommitteenotedthevalueofguidelinessuchasthosepromulgatedbytheHarryBenjaminGenderDsyphoriaAssociationinidentifyingminimumstandardsofcareforpeopleapplyingforsurgery.Summaryof。

9、thereportŸTheproposalisforsurgicalgenderreassignmenttobeavailableforcarefullyselectedtranssexualpeople.Surgeryisnotacosmeticintervention,butonethatattemptstoreconcileanindividual’scoreidentityandtheirphysicalcharacteristics.ŸThereisnocomparablealternativetogenderreassignmentsurgeryinthosewhoareeligibleforsurgery.IndividualswhoarerefusedNHStreatmentmayapproachprivateclinics,bothintheUKandabroad.ŸTheprevalenceoftranssexualismhasnotbeenstudiedinthiscountryinrecentyears.Europeanstudiessuggestthatthe。

10、remaybe150maletranssexualpeopleintheSouthandWestregion,andwemayexpectfiverequestsforsurgicalgenderreassignmenteachyear.ŸCurrentevidenceconsistsofoneprospectivecontrolledstudy,numerouscaseseries,andonecross-sectionalstudy.Moststudiesabouttheeffectivenessofsurgicalgenderreassignmenthavenotcollecteddataprospectivelyandarehamperedbylossestofollowupandlackofvalidatedoutcomemeasures.ŸItisevidentthatanumberofmaletofemaletranssexualpeopleexperience。