Cost‐effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect

Abstract

Objective To compare the cost‐effectiveness of surgery and topical steroids as treatments for phimosis (defined as a clinically verifiable, pathological, cicatricial stenosis of the prepuce) and to evaluate the financial basis of these treatments. Methods Data on treatment using topical steroids was obtained from published reports and those for circumcision from claims by private hospitals for children < 13 years old registered at the health insurance department of our facility. The estimate of the French national financial cost of the treatments for 1998 was calculated from public and private institutional information. Results Treatment with topical steroids for 4–8 weeks was successful in ≈ 85% of patients (mean age 5 years) and had no side‐effects; the remaining 15% were treated by circumcision. Topical steroid therapy costs (in French francs) F 360 per patient. For those primarily treated by circumcision (81 boys, mean age 4.3 years) and diagnosed as having phimosis, the cost was F 3330 per patient in the private sector. The total number of circumcisions performed in France, regardless of sector (public or private) for 1998 was estimated to be 51 080, which represents an annual cost of F 195.7 million. Conclusion As topical pharmacological treatment avoids the disadvantages, trauma and potential complications of penile surgery, including anaesthesia‐related risks, the use of topical steroids as a primary treatment appears to be justified in boys with clinically verifiable phimosis. This treatment could reduce costs by 75%, which represents a potential annual saving of ≈ F 150 million.

Circumcision : A Time to Rethink

“…[3]. Some centers, in an early stage of BXO, have also tried topical application of steroids like clobetasol dipropionate or betamethasone valereate and claim gratifying results to the tune of 70-90% [4,5,6]. In our series, it was noticed that incidence of circumcision carried out in pediatric age group was 2.3 per 1000 population.…”

Wound Care: Traditional African Medicine Approach

“…Currently, conventional medical circumcision is popular in most urban "frican cities [20]. However, the traditional providers will continue to be an important approach to circumcision in especially rural area for various reasons [21].…”

To circ or not to circ: clinical and pharmacoeconomic outcomes of a prospective trial of topical steroid versus primary circumcision

“…There have been few studies comparing the economic impact of circumcision with that of topical treatment in individuals with phimosis. It has been estimated that topical treatment reduces costs by 75% in comparison with circumcision, representing, for example, a potential annual savings of 150 million francs in France (17,18). However, in such studies, costs and treatment outcomes are estimated based on the means obtained in previous studies, and the potential economic risks of future complications are only speculated upon.…”