Costs and effectiveness of neonatal male circumcision.
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.


METHODS
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.


METHODS
United States.


METHODS
Birth cohort of men and women.


METHODS
Decreased MC rates (10% reflects the MC rate in Europe, where insurance coverage is limited).


METHODS
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.


CONCLUSIONS
Continued decreases in MC rates are associated with increased infection prevalence, thereby increasing medical expenditures for men and women.
Department of Pathology, School of Medicine, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287, USA.
Seema
S
Kacker
Kevin D
KD
Frick
Charlotte A
CA
Gaydos
Aaron A R
AA
Tobian
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002944:Circumcision, Male / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D015331:Cohort Studies; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008954:Models, Biological; D018803:Models, Economic; D009010:Monte Carlo Method; D015995:Prevalence; D012749:Sexually Transmitted Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology; D055815:Young Adult