Study Details Humanistic and Economic Burden of Conversion Therapy on LGBTQ Youth

Anna Forsythe, MSc, MBA

A new economic evaluation study detailed the high economic burdens and high societal costs of sexual orientation and gender identity change efforts (SOGICE) , also known as conversion therapy.

Conversion therapy is a dangerous and discredited practice that attempts to convert lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) individuals to be heterosexual and/or cisgender.

A myriad of institutions including the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and other medical, mental health, and human rights organizations have openly opposed the practice, which has long been deemed ineffective and detrimental.

However, limited research has been conducted regarding the overall clinical, humanistic, and economic burden of conversion therapy.

To further elucidate the burdens of the practice and inform legal and health care policy makers, a team led by Anna Forsythe, MSc, MBA, Value and Access at Cytel Inc, conducted a systemic literature review and economic evaluation to quantify the consequences of SOGICE/conversion therapy on young adults.

The Methods

The team conducted the economic evaluation from December 1, 2020 to February 15, 2021 alongside the systemic literature review.

The study included LGTBQ individuals of any age, but retained a focus on adolescents and young adults.

The review compiled broad evidence on conversion therapy and its effects via research questions including the number of individuals, particularly adolescents and young adults, in the US that have undergone SOGICE, the types and duration of therapy, the humanistic and economic harms of SOGICE, and the health care resources and costs associated with SOGICE.

From there, a decision-tree model was developed to assess the costs and consequences of SOGICE compared to no intervention, affirmative therapy versus no intervention, and affirmative therapy versus SOGICE, supplemented with an economic evaluation to assess the overall US economic burden of SOGICE.

Investigators noted that the decision-tree structure accounted for various SOGICE modalities including psychotherapy and religion-based therapy, which incur different costs related to the type of practitioner and duration of therapy.

The Findings

Of the 28 published studies, a total of 190, 695 LGBTQ individuals were included in the study. Among these participants, 12% (range, 7%-23%) of youths experienced SOGICE that was initiated at a mean age of 25 years (range, 5-58 years), with a mean (SD) duration of 26 (29) months.

Approximately 2 types of SOGICE were administered to 43% of all recipients.

Compared to LGBTQ individuals who did not undergo SOGICE, recipients experienced serious psychological distress (47% vs 34%), depression (65% vs 27%), substance abuse (67% vs 50%), and increased suicide rates (58% vs 39%).

Additionally, in the economic analysis and over a lifetime horizon with a 3% annual discount rate, the base-case model featured in the study estimated additional $97 985 lifetime costs per individual, and SOGICE associated with 1.61 QALYs lost compared to no intervention.

Affirmative therapy yielded cost savings of $40,329 with 0.93 QALYs gained versus no intervention.

An estimated 508,892 youths were at risk of SOGICE in 2021, leading the the total annual cost of SOGICE to be estimated at $650.16 million (2021 US dollars), with associated harms totaling an economic burden of $9.23 billion.

The team noted that there have already been various unambiguous statements condemning SOGICE and similar practices from professional societies and human rights groups, and that the current study added to the economic implications of the practice

“It is incumbent on policy makers to act to protect youths from—and stop all funding for—this unacceptable practice,” the team wrote. “Likewise, increasing access to affirmative therapy may promote health by empowering LGBTQ youths with skills and strategies to counteract minority stress”

The study, "Humanistic and Economic Burden of Conversion Therapy Among LGBTQ Youths in the United States," was published online in JAMA Pediatrics.