Study projects increases in health care costs, infections with declines in male circumcision

August 20, 2012

CHICAGO - Using a computer-based simulation model, researchers project that a continued decline in male circumcision rates in the United States to levels in Europe, where the procedure is not routinely covered by insurance, may be associated with increased estimated lifetime medical costs and a higher estimated prevalence of infections including human immunodeficiency virus (HIV) and human papillomavirus (HPV), according to a report published Online First by Archives of Pediatrics & Adolescent Medicine, a JAMA Network publication.

State governments are increasingly eliminating Medicaid coverage for neonatal male circumcision (MC), with 18 states having abolished coverage. Although the prevalence of circumcision among men born in the 1970s and 1980s remained stable at about 79 percent, the MC rate decreased to 62.5 percent in 1999 and to 54.7 percent by 2010. There is growing evidence of medical benefits associated with MC, including lower risk of HIV and HPV infections in some clinical trials, according to the study background.

"Continued decreases in MC rates are associated with increased infection prevalence, thereby increasing medical expenditures for men and women," the study highlights.

Seema Kacker, B.S., and colleagues at Johns Hopkins University, Baltimore, Md., used a computer-based simulation model that included a scenario whereby MC rates would be reduced to 10 percent, which the study results indicate could increase estimated lifetime health care costs by $407 per man and $43 per woman.

Under a 10 percent MC rate among males in a birth cohort of 4 million, cases of infant male urinary tract infections were estimated to increase 211.8 percent, HIV infections were estimated to increase by 12.2 percent, HPV infections were estimated to increase by 29.1 percent and herpes simplex virus type 2 by 19.8 percent. Among women, cases of bacterial vaginosis were estimated to increase by 51.2 percent, high-risk HPV were estimated to increase by 18.3 percent and low-risk HPV by 12.9 percent, according to the study results.

"Although there are multiple factors that contribute to a nation's MC rate, it is likely that reductions in insurance coverage play a role in lowered MC rates. Thus, the financial and health implications of policies that affect MC are substantial," the authors comment.

The researchers conclude: "Furthermore, a closer examination of MC rates, STI [sexually transmitted infection] incidence and the demographic characteristics of Medicaid beneficiaries suggests that the subpopulations likely to quality for Medicaid also have the lowest rates of MC and the highest infection incidence. Therefore, decreased Medicaid coverage of MC may further exaggerate racial and socioeconomic disparities."

(Arch Pediatr Adolesc Med. Published online August 20, 2012. doi:10.1001/archpediatrics.2012.1440. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Authors disclosed grant support from the National Institutes of Health and the Doris Duke Charitable Foundation Clinician Scientist Development Award. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Infant Male Circumcision, Future Health Disparities

In an editorial, Arleen A. Leibowitz, Ph.D., and Katherine Desmond, M.S., of the University of California, Los Angeles, write: "In view of the compelling evidence from randomized controlled trials about the lifelong health benefits of MC and the projections by Kacker et al on the cost-reducing potential of MC, it is now time for the federal Medicaid program to consider reclassifying MC from an 'optional' service to one that all state Medicaid plans will cover for those parents who choose the procedure for their newborn sons."

"States currently facing severe budgetary pressures due to the recession may be tempted to reduce short-term costs by dropping 'optional' benefits, so making MC a required benefit would prevent this sacrifice of long-term gains for near-term relief," they continue.

"Such a change would address three important health system goals: improving health by reducing future incidence of HIV and other STIs, reducing disparities in adult health and lowering treatment costs for STIs in the long run," they conclude.

(Arch Pediatr Adolesc Med. Published online August 20, 2012. doi:10.1001/archpediatrics.2012.1710. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Support for the writing of this editorial was provided by the California HIV/AIDS Research Program of the University of California and the University of California, Los Angeles, Center for HIV Identification, Prevention and Treatment Services, funded by a National Institute of Mental Health grant. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
-end-
To contact Aaron A.R. Tobian, M.D., Ph.D., call David March at 410-955-1534 or email dmarch1@jhmi.edu. To contact editorial author Arleen A. Leibowitz, Ph.D., call Alex Boekelheide at 310-206-0159 or email alex.boekelheide@publicaffairs.ucla.edu.

The JAMA Network Journals

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.