title: Reach and cost-effectiveness of the PrePex device for safe male circumcision in Uganda.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: International Medical Group, Kampala, Uganda.
authors.forename: Kevin
authors.initials: K
authors.lastname: Duffy
authors.forename: Moses
authors.initials: M
authors.lastname: Galukande
authors.forename: Nick
authors.initials: N
authors.lastname: Wooding
authors.forename: Monica
authors.initials: M
authors.lastname: Dea
authors.forename: Alex
authors.initials: A
authors.lastname: Coutinho
mesh_terms: D002944:Circumcision, Male / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation*; D017046:Cost Savings / Q000191:economics; D003362:Cost-Benefit Analysis / Q000191:economics*; D003430:Cross-Sectional Studies; D004864:Equipment and Supplies / Q000009:adverse effects / Q000191:economics*; D015658:HIV Infections / Q000191:economics; D006291:Health Policy / Q000191:economics; D006801:Humans; D008297:Male; D014454:Uganda; D014481:United States; D054702:United States Agency for International Development