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.
Written by:
Kacker S, Frick KD, Gaydos CA, Tobian AA. Are you the author?
Reference: Arch Pediatr Adolesc Med. 2012 Aug 20:1-9.
doi: 10.1001/archpediatrics.2012.1440
PubMed Abstract
PMID: 22911349
UroToday.com Pediatric Urology Section
