Economic Evaluations of Adult Male Circumcision for Prevention of Heterosexual Acquisition of HIV in Men in Sub-Saharan Africa: A Systematic Review

Abstract

BackgroundThere is conclusive evidence from observational data and three randomized controlled trials that circumcised men have a significantly lower risk of becoming infected with the human immunodeficiency virus (HIV). The aim of this study was to systematically review economic evaluations on adult male circumcision (AMC) for prevention of heterosexual acquisition of HIV in men.Methods and FindingsStudies were identified from the following bibliographic databases: MEDLINE (Ovid), EMBASE (Ovid), Cochrane Library (Wiley's internet version), NHS EED and DARE Office of Health Economics HEED. The searches were conducted in November 2009. The Drummond 10-point checklist was used for methodological critique of the economic evaluations. Cost data were inflated and converted to 2008 US dollars (US$). Of 264 identified papers, only five met the inclusion criteria and were included in the review. The studies were published between 2006 and 2009. Most of the studies were carried out from the perspective of government healthcare payer. The time horizon ranged from 10 to 20 years. All studies reported that AMC is cost-effective. The reported cost per HIV infection averted ranged from US$174 to US$2808. The key driver of the cost-effectiveness models was circumcision efficacy.ConclusionsAll published economic evaluations offered the same conclusion that AMC is cost-effective and potentially cost-saving for prevention of heterosexual acquisition of HIV in men. On these grounds, AMC may be seen as a promising new form of strategy for prevention of HIV and should be implemented in conjunction with other evidence-based prevention methods.

Male Circumcision: A Globally Relevant but Under-Utilized Method for the Prevention of HIV and Other Sexually Transmitted Infections

“…In a high HIV prevalence setting, each averted HIV infection would require 5 to 15 circumcision procedures (70). Furthermore, models suggest that as an HIV prevention method, MC is highly cost-effective and potentially cost saving after a period of scale-up (71; 72). While MC programs require initial expenditure for the procedure, potential adverse events, and other components of scale-up, savings are expected to accrue over time as circumcised men, their female partners, and others throughout the community avoid infection with HIV and other STIs.…”

“…MC scale-up to 80% coverage across priority countries in eastern and southern Africa by 2015 is associated with a net savings of $16.51 billion through averted HIV alone (71). Although estimates have varied based on the specifics of the model used and the population studied, a systematic review from 2009 found that reported cost per HIV infection averted through MC ranged from $174 to $2808 (72). These values are comparable to those for other interventions to prevent HIV, such as voluntary testing and counseling, antiretroviral therapy for prevention, and interventions to reduce mother-to-child transmission.…”

Communicable Diseases: Achievements and Challenges for Public Health

“…118,119 Male circumcision is an effective preventive measure to reduce susceptibility to HIV and STI transmission, and is being widely adopted in many African countries. 120,121 There is good reason for cautious optimism given all the progress which has been made in recent years on account of the tremendous efforts in public health. Since 2005, coverage of antiviral treatment in poorer countries has increased tenfold, "resulting in the fi rst decline in the number of AIDS deaths since the epidemic was recognized in the 1980s."…”

The cost-utility analysis of adult male circumcision for prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa: a probabilistic decision model

“…Several economic evaluations [11][12][13][14][15] have shown that AMC is cost effective, or even cost saving (a cost-saving intervention is one that actually saves society money in the long run by preventing costly medical care) for the prevention of heterosexual acquisition of HIV in men. A preliminary examination of the existing economic evaluations suggests that, studies have tended to focus on population in a limited geographic area, have expressed results in terms of cost per HIV infection averted (HIA), or have not considered DALYs [16]. Most of these studies did not include impact of complications association with AMC in their models [16].…”

“…A preliminary examination of the existing economic evaluations suggests that, studies have tended to focus on population in a limited geographic area, have expressed results in terms of cost per HIV infection averted (HIA), or have not considered DALYs [16]. Most of these studies did not include impact of complications association with AMC in their models [16]. Except for Kahn et al [15], most of the authors did not consider multivariate sensitivity analysis.…”