title: Estimating the Cost of Early Infant Male Circumcision in Zimbabwe: Results From a Randomized Noninferiority Trial of AccuCirc Device Versus Mogen Clamp.
abstract: BACKGROUND
  Safe and cost-effective programs for implementing early infant male circumcision (EIMC) in Africa need to be piloted. We present results on a relative cost analysis within a randomized noninferiority trial of EIMC comparing the AccuCirc device with Mogen clamp in Zimbabwe.
  
  
  METHODS
  Between January and June 2013, male infants who met inclusion criteria were randomized to EIMC through either AccuCirc or Mogen clamp conducted by a doctor, using a 2:1 allocation ratio. We evaluated the overall unit cost plus the key cost drivers of EIMC using both AccuCirc and Mogen clamp. Direct costs included consumable and nonconsumable supplies, device, personnel, associated staff training, and environmental costs. Indirect costs comprised capital and support personnel costs. In 1-way sensitivity analyses, we assessed potential changes in unit costs due to variations in main parameters, one at a time, holding all other values constant.
  
  
  RESULTS
  The unit costs of EIMC using AccuCirc and Mogen clamp were $49.53 and $55.93, respectively. Key cost drivers were consumable supplies, capacity utilization, personnel costs, and device price. Unit prices are likely to be lowest at full capacity utilization and increase as capacity utilization decreases. Unit prices also fall with lower personnel salaries and increase with higher device prices.
  
  
  CONCLUSIONS
  EIMC has a lower unit cost when using AccuCirc compared with Mogen clamp. To minimize unit costs, countries planning to scale-up EIMC using AccuCirc need to control costs of consumables and personnel. There is also need to negotiate a reasonable device price and maximize capacity utilization.
authors.affiliation: *Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe; †University College London, London, United Kingdom; ‡Population Services International, Harare, Zimbabwe; §University of North Carolina at Chapel Hill, Chapel Hill, NC; ‖Ministry of Health and Child Care, Harare, Zimbabwe; and ¶University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
authors.forename: Collin
authors.initials: C
authors.lastname: Mangenah
authors.forename: Webster
authors.initials: W
authors.lastname: Mavhu
authors.forename: Karin
authors.initials: K
authors.lastname: Hatzold
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Biddle
authors.forename: Ngonidzashe
authors.initials: N
authors.lastname: Madidi
authors.forename: Getrude
authors.initials: G
authors.lastname: Ncube
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
authors.forename: Ismail
authors.initials: I
authors.lastname: Ticklay
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
authors.forename: Harsha
authors.initials: H
authors.lastname: Thirumurthy
mesh_terms: D002944:Circumcision, Male / Q000191:economics* / Q000193:education / Q000295:instrumentation* / Q000379:methods; D003365:Costs and Cost Analysis; D006282:Health Personnel / Q000191:economics / Q000193:education; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007318:Inservice Training / Q000191:economics; D008297:Male; D013525:Surgical Instruments / Q000191:economics*; D013997:Time Factors; D015030:Zimbabwe