Is male circumcision a cost-effective intervention in reducing HIV?
Evaluation of the evidence on the effectiveness of male circumcision (MC) suggests that implementation should be accelerated in sub-Saharan Africa. Experts reviewing six simulation models agree that programmes that focus on subpopulations with a high HIV prevalence and incidence would have substantial impact on HIV incidence.
The review of the six simulation models found estimates of costs per HIV infections averted (HIA) between $150 and $900 in high HIV prevalence settings over a 10-year time horizon, and $100 to $400 when including infections averted to 20 year. Cost-effectiveness models from individual studies estimate (download the full report for references):
- With an HIV prevalence of 8.4%, the cost per HIA is $551 (80% CI $344–$1,071) and net savings are $753,000 (80% CI $0.3 million to $1.2 million) based on data from South Africa.
- Research using data from Uganda estimated the cost per HIA to be $1,269–3,911.
- Modelling impact and costs of MC for Eastern and Southern Africa research estimates net savings for Zimbabwe to be US$7,031 for 2011-2025.
- Costs per HIA based on Rwandan data is US$3,932 for adolescent MC and US$4,949 for adult MC. This study also investigated neonatal MC which is considerably less expensive, US$15 instead of US$59 per procedure, though savings will be realised later in time.
- Estimates from Tanzanian data suggest costs per HIA to be US$11,300 during 2010–2015 and US$3,200 during 2010–2025.
- The USAID Health Policy Initiative estimated cost-effectiveness in the settings of Swaziland, Zambia, and Lesotho. Costs per HIA were US$176 in Swaziland, US$313 in Zambia, and US$292 in Lesotho.
Bolton, L. Helpdesk Report: Cost-effectiveness of male circumcision in reducing HIV. Health and Education Advice and Resource Team (HEART), Oxford, UK (2016) 13 pp.