Costs and effectiveness of neonatal male circumcision

Arch Pediatr Adolesc Med. 2012 Oct;166(10):910-8. doi: 10.1001/archpediatrics.2012.1440.

Abstract

Objective: To evaluate the expected change in the prevalence of male circumcision (MC)-reduced infections and resulting health care costs associated with continued decreases in MC rates. During the past 20 years, MC rates have declined from 79% to 55%, alongside reduced insurance coverage.

Design: We used Markov-based Monte Carlo simulations to track men and women throughout their lifetimes as they experienced MC procedure-related events and MC-reduced infections and accumulated associated costs. One-way and probabilistic sensitivity analyses were used to evaluate the impact of uncertainty.

Setting: United States.

Participants: Birth cohort of men and women.

Intervention: Decreased MC rates (10% reflects the MC rate in Europe, where insurance coverage is limited).

Outcomes measured: Lifetime direct medical cost (2011 US$) and prevalence of MC-reduced infections.

Results: Reducing the MC rate to 10% will increase lifetime health care costs by $407 per male and $43 per female. Net expenditure per annual birth cohort (including procedure and complication costs) is expected to increase by $505 million, reflecting an increase of $313 per forgone MC. Over 10 annual cohorts, net present value of additional costs would exceed $4.4 billion. Lifetime prevalence of human immunodeficiency virus infection among males is expected to increase by 12.2% (4843 cases), high- and low-risk human papillomavirus by 29.1% (57 124 cases), herpes simplex virus type 2 by 19.8% (124 767 cases), and infant urinary tract infections by 211.8% (26 876 cases). Among females, lifetime prevalence of bacterial vaginosis is expected to increase by 51.2% (538 865 cases), trichomoniasis by 51.2% (64 585 cases), high-risk human papillomavirus by 18.3% (33 148 cases), and low-risk human papillomavirus by 12.9% (25 837 cases). Increased prevalence of human immunodeficiency virus infection among males represents 78.9% of increased expenses.

Conclusion: Continued decreases in MC rates are associated with increased infection prevalence, thereby increasing medical expenditures for men and women.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Circumcision, Male / economics*
  • Circumcision, Male / statistics & numerical data
  • Circumcision, Male / trends
  • Cohort Studies
  • Computer Simulation
  • Cost-Benefit Analysis
  • Female
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Infant, Newborn
  • Male
  • Markov Chains
  • Middle Aged
  • Models, Biological
  • Models, Economic
  • Monte Carlo Method
  • Prevalence
  • Sexually Transmitted Diseases / economics
  • Sexually Transmitted Diseases / epidemiology
  • Sexually Transmitted Diseases / prevention & control*
  • United States / epidemiology
  • Young Adult