Male circumcision (MC) is an effective intervention to reduce HIV acquisition in men in Africa. We conducted a cost analysis using longitudinal data on expenditures on services and community mobilization to estimate the marginal cost of MC over time and understand cost drivers during scale up. We used a time-series with monthly records from 2008 to 2013, for a total of 72 monthly observations, from the Rakai MC program in Uganda. GLM models were used to estimate the marginal cost of a MC procedure. The marginal cost per MC in a mobile camp was $23 (p<0.01) and in static facilities was $35 (p<0.1). Major cost drivers included supplies in mobile camps with increasing number of surgeries, savings due to task shifting from physicians to clinical officers and increased efficiency as personnel became more experienced. As scale up continues, marginal costs may increase due to mobilization needed for less motivated late adopters, but improved efficiency could contain costs.

Suicide among adolescents is a significant public health concern in the U.S., especially within American Indian and Alaska Native (AIAN) communities. Lack of quality of life (QoL) estimates for both suicide ideation and depression specific to the AIAN population hinders the ability to compare interventions in cost-effectiveness analysis. We surveyed 200 AI youth and young adults from the Fort Apache Indian Reservation to estimate utility weights for experiencing suicide ideation and depression. Our results indicate that, on a scale of 0–100, with higher scores indicating better health, the general community rates both suicide ideation and depression at 15.8 and 25.1, respectively. These weights are statistically significantly different and lower than for other cultures. Culturally specific QoL values will allow the comparison and identification of the most effective and feasible interventions to reduce the suicide burden among tribal communities.

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