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.
Value-added from male circumcision comes from reduction in other sexually transmitted diseases.
Cost-effectiveness estimates identified are promising but vary widely, making it difficult to draw conclusions. Estimates are sensitive to inputs such as costing of the MC and treatment averted, the protective effect, and HIV prevalence. Estimates are also likely to vary over time due to inflation.