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Cost savings in male circumcision post-operative care using two-way text-based follow-up in rural and urban South Africa

Author

Listed:
  • Yanfang Su
  • Rachel Mukora
  • Felex Ndebele
  • Jacqueline Pienaar
  • Calsile Khumalo
  • Xinpeng Xu
  • Hannock Tweya
  • Maria Sardini
  • Sarah Day
  • Kenneth Sherr
  • Geoffrey Setswe
  • Caryl Feldacker

Abstract

Introduction: Voluntary medical male circumcision (VMMC) clients are required to attend multiple post-operative follow-up visits in South Africa. However, with demonstrated VMMC safety, stretched clinic staff in SA may conduct more than 400,000 unnecessary reviews for males without complications, annually. Embedded into a randomized controlled trial (RCT) to test safety of two-way, text-based (2wT) follow-up as compared to routine in-person visits among adult clients, the objective of this study was to compare 2wT and routine post-VMMC care costs in rural and urban South African settings. Methods: Activity-based costing (ABC) estimated the costs of post-VMMC care, including counselling, follow-ups, and tracing in $US dollars. Transportation for VMMC and follow-up was provided for rural clients in outreach settings but not for urban clients in static sites. Data were collected from National Department of Health VMMC forms, RCT databases, and time-and-motion surveys. Sensitivity analysis presents different follow-up scenarios. We hypothesized that 2wT would save per-client costs overall, with higher savings in rural settings. Results: VMMC program costs were estimated from 1,084 RCT clients: 537 in routine care and 547 in 2wT. On average, 2wT saved $3.56 per client as compared to routine care. By location, 2wT saved $7.73 per rural client and increased urban costs by $0.59 per client. 2wT would save $2.16 and $7.02 in follow-up program costs if men attended one or two post-VMMC visits, respectively. Conclusion: Quality 2wT follow-up care reduces overall post-VMMC care costs by supporting most men to heal at home while triaging clients with potential complications to timely, in-person care. 2wT saves more in rural areas where 2wT offsets transportation costs. Minimal additional 2wT costs in urban areas reflect high care quality and client engagement, a worthy investment for improved VMMC service delivery. 2wT scale-up in South Africa could significantly reduce overall VMMC costs while maintaining service quality.

Suggested Citation

  • Yanfang Su & Rachel Mukora & Felex Ndebele & Jacqueline Pienaar & Calsile Khumalo & Xinpeng Xu & Hannock Tweya & Maria Sardini & Sarah Day & Kenneth Sherr & Geoffrey Setswe & Caryl Feldacker, 2023. "Cost savings in male circumcision post-operative care using two-way text-based follow-up in rural and urban South Africa," PLOS ONE, Public Library of Science, vol. 18(11), pages 1-16, November.
    • Handle: RePEc:plo:pone00:0294449
    DOI: 10.1371/journal.pone.0294449
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    References listed on IDEAS

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    1. repec:plo:pone00:0218137 is not listed on IDEAS
    2. 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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