title: The cost-utility analysis of adult male circumcision for prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa: a probabilistic decision model.
abstract: OBJECTIVE
  The aim of this study was to assess the cost-utility of adult male circumcision (AMC) versus no AMC in the prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa.
  
  
  METHODS
  A decision tree was constructed and parameterized using data from published sources. The economic evaluation was conducted from the perspective of government health care payer. Benefits (disability adjusted life years [DALYs]) and costs were discounted at 3%. Costs were assessed in 2008 US dollars. One-way and probabilistic sensitivity analyses were conducted to assess the stability of the base-case results. The uncertainty surrounding the estimates of cost effectiveness was illustrated through a cost-effectiveness acceptability curve and cost-effectiveness plane.
  
  
  RESULTS
  In the base-case analysis, AMC can be regarded as cost saving because it is associated with higher DALYs gained and lower costs than no AMC. The probability that AMC is cost effective is above 0.96 at a threshold value of $150 and remains high over a wide range of threshold values. Thus, there is very little uncertainty surrounding the decision to adopt AMC for prevention of heterosexual acquisition of HIV in men. The results were found to be sensitive to varying any of the following parameters: DALYs averted, discount, and circumcision efficacy.
  
  
  CONCLUSIONS
  AMC is found to be cost saving. AMC may be seen as a promising new form of strategy for prevention of heterosexual acquisition of HIV in men, but should never replace other known methods of HIV prevention and should always be considered as part of a comprehensive HIV prevention package.
authors.affiliation: The West Midlands Health Technology Assessment Collaboration (WMHTAC), University of Birmingham, Public Health, Epidemiology & Biostatistics, Edgbaston, Birmingham, UK. uthlekan@yahoo.com
authors.forename: Olalekan A
authors.initials: OA
authors.lastname: Uthman
authors.forename: Taiwo Aderemi
authors.initials: TA
authors.lastname: Popoola
authors.forename: Ismail
authors.initials: I
authors.lastname: Yahaya
authors.forename: Mubashir M B
authors.initials: MM
authors.lastname: Uthman
authors.forename: Olatunde
authors.initials: O
authors.lastname: Aremu
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D002944:Circumcision, Male / Q000191:economics*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D015658:HIV Infections / Q000191:economics / Q000517:prevention & control*; D017048:Health Care Costs; D006801:Humans; D016015:Logistic Models; D008297:Male; D017059:Models, Econometric; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years