title: Comparative Cost Analysis of Surgical and PrePex Device Male Circumcision in Zimbabwe and Mozambique.
abstract: BACKGROUND
  The PrePex device has proven to be safe for voluntary medical male circumcision (VMMC) in adults in several African countries. Costing studies were conducted as part of a PrePex/Surgery comparison study in Zimbabwe and a pilot implementation study in Mozambique.
  
  
  METHODS
  The studies calculated per male circumcision unit costs using a cost-analysis approach. Both direct costs (consumable and nonconsumable supplies, device, personnel, associated staff training) and selected indirect costs (capital and support personnel costs) were calculated.
  
  
  RESULTS
  The cost comparison in Zimbabwe showed a unit cost per VMMC of $45.50 for PrePex and $53.08 for surgery. The unit cost difference was based on higher personnel and consumable supplies costs for the surgical procedure, which used disposable instrument kits. In Mozambique, the costing analysis estimated a higher unit cost for PrePex circumcision ($40.66) than for surgery ($20.85) because of higher consumable costs, particularly the PrePex device and lower consumable supplies costs for the surgical procedure using reusable instruments. Supplies and direct staff costs contributed 87.2% for PrePex and 65.8% for surgical unit costs in Mozambique.
  
  
  CONCLUSIONS
  PrePex device male circumcision could potentially be cheaper than surgery in Zimbabwe, especially in settings that lack the infrastructure and personnel required for surgical VMMC, and this might result in programmatic cost savings. In Mozambique, the surgical procedure seems to be less costly compared with PrePex mainly because of higher consumable supplies costs. With reduced device unit costs, PrePex VMMC could become more cost-efficient and considered as complementary for Mozambique's VMMC scale-up program.
authors.affiliation: *Strategic Development Consultants, South Africa; †ZICHIRE, Zimbabwe; ‡Ministry of Health and Child Care, Harare, Zimbabwe; §Ministry of Health, Mozambique; ‖Jhpiego, Baltimore; ¶Jhpiego, Mozambique; #PSI, Mozambique; and **Population Services International, Harare, Zimbabwe.
authors.forename: Carl
authors.initials: C
authors.lastname: Schutte
authors.forename: M
authors.initials: M
authors.lastname: Tshimanga
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
authors.forename: Iotamo
authors.initials: I
authors.lastname: Come
authors.forename: Edgar
authors.initials: E
authors.lastname: Necochea
authors.forename: Mehebub
authors.initials: M
authors.lastname: Mahomed
authors.forename: Sinokuthemba
authors.initials: S
authors.lastname: Xaba
authors.forename: Debora
authors.initials: D
authors.lastname: Bossemeyer
authors.forename: Thais
authors.initials: T
authors.lastname: Ferreira
authors.forename: Lucinda
authors.initials: L
authors.lastname: Macaringue
authors.forename: Pessanai
authors.initials: P
authors.lastname: Chatikobo
authors.forename: Patricia
authors.initials: P
authors.lastname: Gundididza
authors.forename: Karin
authors.initials: K
authors.lastname: Hatzold
mesh_terms: D002944:Circumcision, Male / Q000191:economics* / Q000295:instrumentation; D003365:Costs and Cost Analysis; D006801:Humans; D008297:Male; D009073:Mozambique; D015030:Zimbabwe