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Reach and Cost-Effectiveness of the PrePex Device for Safe Male Circumcision in Uganda

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  • Kevin Duffy
  • Moses Galukande
  • Nick Wooding
  • Monica Dea
  • Alex Coutinho

Abstract

Introduction: Modelling, supported by the USAID Health Policy Initiative and UNAIDS, performed in 2011, indicated that Uganda would need to perform 4.2 million medical male circumcisions (MMCs) to reach 80% prevalence. Since 2010 Uganda has completed 380,000 circumcisions, and has set a national target of 1 million for 2013. Objective: To evaluate the relative reach and cost-effectiveness of PrePex compared to the current surgical SMC method and to determine the effect that this might have in helping to achieve the Uganda national SMC targets. Methods: A cross-sectional descriptive cost-analysis study conducted at International Hospital Kampala over ten weeks from August to October 2012. Data collected during the performance of 625 circumcisions using PrePex was compared to data previously collected from 10,000 circumcisions using a surgical circumcision method at the same site. Ethical approval was obtained. Results: The moderate adverse events (AE) ratio when using the PrePex device was 2% and no severe adverse events were encountered, which is comparable to the surgical method, thus the AE rate has no effect on the reach or cost-effectiveness of PrePex. The unit cost to perform one circumcision using PrePex is $30.55, 35% ($7.90) higher than the current surgical method, but the PrePex method improves operator efficiency by 60%, meaning that a team can perform 24 completed circumcisions compared to 15 by the surgical method. The cost-effectiveness of PrePex, comparing the cost of performing circumcisions to the future cost savings of potentially averted HIV infections, is just 2% less than the current surgical method, at a device cost price of $20. Conclusion: PrePex is a viable SMC tool for scale-up with unrivalled potential for superior reach, however national targets can only be met with effective demand creation and availability of trained human resource.

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0063134
    DOI: 10.1371/journal.pone.0063134
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    References listed on IDEAS

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    1. 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.
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    1. 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.
    2. Emmanuel Njeuhmeli & Katharine Kripke & Karin Hatzold & Jason Reed & Dianna Edgil & Juan Jaramillo & Delivette Castor & Steven Forsythe & Sinokuthemba Xaba & Owen Mugurungi, 2014. "Cost Analysis of Integrating the PrePex Medical Device into a Voluntary Medical Male Circumcision Program in Zimbabwe," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-7, May.

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