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Cost Analysis of Integrating the PrePex Medical Device into a Voluntary Medical Male Circumcision Program in Zimbabwe

Author

Listed:
  • Emmanuel Njeuhmeli
  • Katharine Kripke
  • Karin Hatzold
  • Jason Reed
  • Dianna Edgil
  • Juan Jaramillo
  • Delivette Castor
  • Steven Forsythe
  • Sinokuthemba Xaba
  • Owen Mugurungi

Abstract

Background: Fourteen African countries are scaling up voluntary medical male circumcision (VMMC) for HIV prevention. Several devices that might offer alternatives to the three WHO-approved surgical VMMC procedures have been evaluated for use in adults. One such device is PrePex, which was prequalified by the WHO in May 2013. We utilized data from one of the PrePex field studies undertaken in Zimbabwe to identify cost considerations for introducing PrePex into the existing surgical circumcision program. Methods and Findings: We evaluated the cost drivers and overall unit cost of VMMC at a site providing surgical VMMC as a routine service (“routine surgery site”) and at a site that had added PrePex VMMC procedures to routine surgical VMMC as part of a research study (“mixed study site”). We examined the main cost drivers and modeled hypothetical scenarios with varying ratios of surgical to PrePex circumcisions, different levels of site utilization, and a range of device prices. The unit costs per VMMC for the routine surgery and mixed study sites were $56 and $61, respectively. The two greatest contributors to unit price at both sites were consumables and staff. In the hypothetical scenarios, the unit cost increased as site utilization decreased, as the ratio of PrePex to surgical VMMC increased, and as device price increased. Conclusions: VMMC unit costs for routine surgery and mixed study sites were similar. Low service utilization was projected to result in the greatest increases in unit price. Countries that wish to incorporate PrePex into their circumcision programs should plan to maximize staff utilization and ensure that sites function at maximum capacity to achieve the lowest unit cost. Further costing studies will be necessary once routine implementation of PrePex-based circumcision is established.

Suggested Citation

  • 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.
  • Handle: RePEc:plo:pone00:0082533
    DOI: 10.1371/journal.pone.0082533
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    References listed on IDEAS

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    1. Walter Obiero & Marisa R Young & Robert C Bailey, 2013. "The PrePex Device Is Unlikely to Achieve Cost-Savings Compared to the Forceps-Guided Method in Male Circumcision Programs in Sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 8(1), pages 1-6, January.
    2. 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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