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Estimating the Resources Needed and Savings Anticipated from Roll-Out of Adult Male Circumcision in Sub-Saharan Africa

Author

Listed:
  • Bertran Auvert
  • Elliot Marseille
  • Eline L Korenromp
  • James Lloyd-Smith
  • Remi Sitta
  • Dirk Taljaard
  • Carel Pretorius
  • Brian Williams
  • James G Kahn

Abstract

Background: Trials in Africa indicate that medical adult male circumcision (MAMC) reduces the risk of HIV by 60%. MAMC may avert 2 to 8 million HIV infections over 20 years in sub-Saharan Africa and cost less than treating those who would have been infected. This paper estimates the financial and human resources required to roll out MAMC and the net savings due to reduced infections. Methods: We developed a model which included costing, demography and HIV epidemiology. We used it to investigate 14 countries in sub-Saharan Africa where the prevalence of male circumcision was lower than 80% and HIV prevalence among adults was higher than 5%, in addition to Uganda and the Nyanza province in Kenya. We assumed that the roll-out would take 5 years and lead to an MC prevalence among adult males of 85%. We also assumed that surgery would be done as it was in the trials. We calculated public program cost, number of full-time circumcisers and net costs or savings when adjusting for averted HIV treatments. Costs were in USD, discounted to 2007. 95% percentile intervals (95% PI) were estimated by Monte Carlo simulations. Results: In the first 5 years the number of circumcisers needed was 2 282 (95% PI: 2 018 to 2 959), or 0.24 (95% PI: 0.21 to 0.31) per 10 000 adults. In years 6–10, the number of circumcisers needed fell to 513 (95% PI: 452 to 664). The estimated 5-year cost of rolling out MAMC in the public sector was $919 million (95% PI: 726 to 1 245). The cumulative net cost over the first 10 years was $672 million (95% PI: 437 to 1 021) and over 20 years there were net savings of $2.3 billion (95% PI: 1.4 to 3.4). Conclusion: A rapid roll-out of MAMC in sub-Saharan Africa requires substantial funding and a high number of circumcisers for the first five years. These investments are justified by MAMC's substantial health benefits and the savings accrued by averting future HIV infections. Lower ongoing costs and continued care savings suggest long-term sustainability.

Suggested Citation

  • Bertran Auvert & Elliot Marseille & Eline L Korenromp & James Lloyd-Smith & Remi Sitta & Dirk Taljaard & Carel Pretorius & Brian Williams & James G Kahn, 2008. "Estimating the Resources Needed and Savings Anticipated from Roll-Out of Adult Male Circumcision in Sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 3(8), pages 1-8, August.
    • Handle: RePEc:plo:pone00:0002679
    DOI: 10.1371/journal.pone.0002679
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    References listed on IDEAS

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    5. James G Kahn & Elliot Marseille & Bertran Auvert, 2006. "Cost-Effectiveness of Male Circumcision for HIV Prevention in a South African Setting," PLOS Medicine, Public Library of Science, vol. 3(12), pages 1-10, December.
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    1. Djesika D Amendah & George Mukamah & Albert Komba & Carolyne Ndila & Thomas N Williams, 2013. "Routine Paediatric Sickle Cell Disease (SCD) Outpatient Care in a Rural Kenyan Hospital: Utilization and Costs," PLOS ONE, Public Library of Science, vol. 8(4), pages 1-6, April.
    2. Olalekan A Uthman & Taiwo Aderemi Popoola & Mubashir M B Uthman & Olatunde Aremu, 2010. "Economic Evaluations of Adult Male Circumcision for Prevention of Heterosexual Acquisition of HIV in Men in Sub-Saharan Africa: A Systematic Review," PLOS ONE, Public Library of Science, vol. 5(3), pages 1-7, March.
    3. Veena Menon & Elizabeth Gold & Ramona Godbole & Delivette Castor & Hally Mahler & Steven Forsythe & Mariam Ally & Emmanuel Njeuhmeli, 2014. "Costs and Impacts of Scaling up Voluntary Medical Male Circumcision in Tanzania," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-8, May.
    4. Rosa Macipe-Costa & Nuria García-Sanchez & Luis Gimeno-Feliu & Beatriz Navarra-Vicente & Juan Jiménez-Hereza & Isabel Moneo-Hernández & Jose Castillo-Laita & Pilar Lobera-Navaz, 2014. "Non-therapeutic male circumcision performed on immigrant children from Africa in Spain," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 59(2), pages 351-358, April.
    5. Bruce Larson & Allan Tindikahwa & George Mwidu & Hannah Kibuuka & Fred Magala, 2015. "How Much Does It Cost to Improve Access to Voluntary Medical Male Circumcision among High-Risk, Low-Income Communities in Uganda?," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-11, March.

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