Circumcision for prevention of HIV: new analysis demonstrates cost-effectiveness

December 25, 2006

A team of researchers who conducted a landmark trial in Orange Farm, South Africa, which concluded that male circumcision can sub stantially reduce the risk of becoming infected with HIV, have now studied the economic aspects of this approach to preventing HIV/AIDS. Their new research, published in PLoS Medicine, suggests that circumcision could reduce the cost of health care in South Africa (and other sub-Saharan Countries), mainly through savings on the cost of HIV treatment.

The researchers carried out a set of calculations, using the results from their major â€ËœOrange Farm trialâ€TM, and making other assumptions based on data from elsewhere. Their mathematical model was based on a hypothetical group of 1,000 men, all of whom would be circumcised. The researchers calculated that in such a hypothetical group, the cost of providing male circumcision, per HIV infection prevented, would be around $180. Overall, this procedure seemed to be cost-saving when the cost of HIV treatment was considered; around $2.4 million would be saved for the 1,000 men circumcised.

The overall cost of male circumcision, per HIV infection prevented, is reasonable as compared to the costs of other strategies for prevention of HIV. There would also be implications for HIV prevention programs in other African countries.
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Additional notes:

1. The ground-breaking Orange Farm study was first published in PLoS Medicine in October 2005. http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020298 2. Within the last few days, it has been announced that two further trials of circumcision for HIV prevention, conducted by research teams in East Africa, have been stopped early. It became clear that the rate of new HIV infections was much lower in circumcised men, compared with uncircumcised men. It was therefore considered that continuing the trials would be unethical. The full results of the East African tr ials have not yet been published. 3. Researchers do not suggest that being circumcised eliminates the risk of HIV infection. It merely reduces it. Other measures to prevent infection are still essential.

Citation: Kahn JG, Marseille E, Auvert B (2006) Cost-effectiveness of male circumcision for HIV prevention in a South African setting. PLoS Med 3(12): e517.

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CONTACT

James Kahn
University of California San Francisco
Inst Health Policy Studies
3333 Califor nia Street
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jgkahn@ucsf.edu

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