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Cost-Effectiveness of Male Circumcision for HIV Prevention in a South African Setting

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  • James G Kahn
  • Elliot Marseille
  • Bertran Auvert

Abstract

Background: Consistent with observational studies, a randomized controlled intervention trial of adult male circumcision (MC) conducted in the general population in Orange Farm (OF) (Gauteng Province, South Africa) demonstrated a protective effect against HIV acquisition of 60%. The objective of this study is to present the first cost-effectiveness analysis of the use of MC as an intervention to reduce the spread of HIV in sub-Saharan Africa. Methods and Findings: Cost-effectiveness was modeled for 1,000 MCs done within a general adult male population. Intervention costs included performing MC and treatment of adverse events. HIV prevalence was estimated from published estimates and incidence among susceptible subjects calculated assuming a steady-state epidemic. Effectiveness was defined as the number of HIV infections averted (HIA), which was estimated by dynamically projecting over 20 years the reduction in HIV incidence observed in the OF trial, including secondary transmission to women. Net savings were calculated with adjustment for the averted lifetime duration cost of HIV treatment. Sensitivity analyses examined the effects of input uncertainty and program coverage. All results were discounted to the present at 3% per year. Conclusions: In settings in sub-Saharan Africa with high or moderate HIV prevalence among the general population, adult MC is likely to be a cost-effective HIV prevention strategy, even when it has a low coverage. MC generates large net savings after adjustment for averted HIV medical costs. Based on data from a trial of adult male circumcision to reduce the spread of HIV, a modeling study shows this intervention to be a cost-effective strategy. :

Suggested Citation

  • James G Kahn & Elliot Marseille & Bertran Auvert, 2006. "Cost-Effectiveness of Male Circumcision for HIV Prevention in a South African Setting," PLOS Medicine, Public Library of Science, vol. 3(12), pages 1-10, December.
    • Handle: RePEc:plo:pmed00:0030517
    DOI: 10.1371/journal.pmed.0030517
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    Cited by:

    1. Paul Gavaza & Karen Rascati & Abiola Oladapo & Star Khoza, 2012. "The State of Health Economic Research in South Africa," PharmacoEconomics, Springer, vol. 30(10), pages 925-940, October.
    2. Jessica B McGillen & John Stover & Daniel J Klein & Sinokuthemba Xaba & Getrude Ncube & Mutsa Mhangara & Geraldine N Chipendo & Isaac Taramusi & Leo Beacroft & Timothy B Hallett & Patrick Odawo & Rumb, 2018. "The emerging health impact of voluntary medical male circumcision in Zimbabwe: An evaluation using three epidemiological models," PLOS ONE, Public Library of Science, vol. 13(7), pages 1-17, July.
    3. Steffen Flessa, 2009. "Cost effectiveness of antiretrovirals — long term or short term?," Applied Health Economics and Health Policy, Springer, vol. 7(4), pages 225-227, December.
    4. Olalekan A Uthman & Taiwo Aderemi Popoola & Mubashir M B Uthman & Olatunde Aremu, 2010. "Economic Evaluations of Adult Male Circumcision for Prevention of Heterosexual Acquisition of HIV in Men in Sub-Saharan Africa: A Systematic Review," PLOS ONE, Public Library of Science, vol. 5(3), pages 1-7, March.
    5. Bertran Auvert & Elliot Marseille & Eline L Korenromp & James Lloyd-Smith & Remi Sitta & Dirk Taljaard & Carel Pretorius & Brian Williams & James G Kahn, 2008. "Estimating the Resources Needed and Savings Anticipated from Roll-Out of Adult Male Circumcision in Sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 3(8), pages 1-8, August.
    6. James G Kahn & Nicholas Muraguri & Brian Harris & Eric Lugada & Thomas Clasen & Mark Grabowsky & Jonathan Mermin & Shahnaaz Shariff, 2012. "Integrated HIV Testing, Malaria, and Diarrhea Prevention Campaign in Kenya: Modeled Health Impact and Cost-Effectiveness," PLOS ONE, Public Library of Science, vol. 7(2), pages 1-9, February.
    7. Margaret Brandeau & Gregory Zaric, 2009. "Optimal investment in HIV prevention programs: more is not always better," Health Care Management Science, Springer, vol. 12(1), pages 27-37, March.
    8. Elliot Marseille & James Kahn & Christian Pitter & Rebecca Bunnell & William Epalatai & Emmanuel Jawe & Willy Were & Jonathan Mermin, 2009. "The cost effectiveness of home-based provision of antiretroviral therapy in rural Uganda," Applied Health Economics and Health Policy, Springer, vol. 7(4), pages 229-243, December.
    9. Bruce Larson & Allan Tindikahwa & George Mwidu & Hannah Kibuuka & Fred Magala, 2015. "How Much Does It Cost to Improve Access to Voluntary Medical Male Circumcision among High-Risk, Low-Income Communities in Uganda?," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-11, March.
    10. Michel Tchuenche & Eurica Palmer & Vibhuti Haté & Ananthy Thambinayagam & Dayanund Loykissoonlal & Emmanuel Njeuhmeli & Steven Forsythe, 2016. "The Cost of Voluntary Medical Male Circumcision in South Africa," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-17, October.
    11. Dickens S Omondi Aduda & Collins Ouma & Rosebella Onyango & Mathews Onyango & Jane Bertrand, 2015. "Voluntary Medical Male Circumcision Scale-Up in Nyanza, Kenya: Evaluating Technical Efficiency and Productivity of Service Delivery," PLOS ONE, Public Library of Science, vol. 10(2), pages 1-17, February.
    12. Michel Tchuenche & Vibhuti Haté & Dacia McPherson & Eurica Palmer & Ananthy Thambinayagam & Dayanund Loykissoonlal & Emmanuel Njeuhmeli & Steven Forsythe, 2016. "Estimating Client Out-of-Pocket Costs for Accessing Voluntary Medical Male Circumcision in South Africa," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-10, October.
    13. Kevin Duffy & Moses Galukande & Nick Wooding & Monica Dea & Alex Coutinho, 2013. "Reach and Cost-Effectiveness of the PrePex Device for Safe Male Circumcision in Uganda," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-6, May.

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