title: Cost analysis of integrating the PrePex medical device into a voluntary medical male circumcision program in Zimbabwe.
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.
  
  
  RESULTS
  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.
authors.affiliation: United States Agency for International Development, Washington, DC, United States of America.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Njeuhmeli
authors.affiliation: Health Policy Initiative, Futures Institute, Washington, DC, United States of America.
authors.forename: Katharine
authors.initials: K
authors.lastname: Kripke
authors.affiliation: Population Services International, Harare, Zimbabwe.
authors.forename: Karin
authors.initials: K
authors.lastname: Hatzold
authors.affiliation: Office of the U.S. Global AIDS Coordinator, Washington, DC, United States of America.
authors.forename: Jason
authors.initials: J
authors.lastname: Reed
authors.affiliation: United States Agency for International Development, Washington, DC, United States of America.
authors.forename: Dianna
authors.initials: D
authors.lastname: Edgil
authors.affiliation: The Partnership for Supply Chain Management System, Arlington, Virginia, United States of America.
authors.forename: Juan
authors.initials: J
authors.lastname: Jaramillo
authors.affiliation: United States Agency for International Development, Washington, DC, United States of America.
authors.forename: Delivette
authors.initials: D
authors.lastname: Castor
authors.affiliation: Health Policy Initiative, Futures Institute, Washington, DC, United States of America.
authors.forename: Steven
authors.initials: S
authors.lastname: Forsythe
authors.affiliation: Zimbabwe Ministry of Health and Child Welfare, Harare, Zimbabwe.
authors.forename: Sinokuthemba
authors.initials: S
authors.lastname: Xaba
authors.affiliation: Zimbabwe Ministry of Health and Child Welfare, Harare, Zimbabwe.
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
mesh_terms: D002944:Circumcision, Male / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D003362:Cost-Benefit Analysis; D004864:Equipment and Supplies / Q000191:economics*; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000191:economics; D015030:Zimbabwe