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Cost analysis of neonatal circumcision in a large health maintenance organization
Edgar J Schoen1, Christopher J Colby, Trinh T To
1Department of Genetics, Kaiser Permanente Medical Center and Division of Research, Kaiser Permanente Medical Care Program, Oakland, California 94611-5693, USA. edgar.schoen@kp.org
Insights
Newborn circumcision offers significant lifetime health benefits with minimal cost. Delaying circumcision increases expenses substantially, highlighting the importance of early procedures for cost-effectiveness.
Area of Science:
- Medical Economics
- Pediatric Health
- Public Health Policy
Background:
- Neonatal circumcision is a common procedure with debated cost-benefit analyses.
- Understanding the long-term economic implications of circumcision timing is crucial for healthcare policy.
- Previous studies have not fully captured the lifetime costs and benefits of newborn circumcision.
Purpose of the Study:
- To evaluate the economic costs of newborn circumcision in relation to its long-term health benefits.
- To compare the costs of neonatal circumcision versus medically indicated postneonatal circumcision.
- To determine the overall cost-effectiveness of newborn circumcision for male infants.
Main Methods:
- Retrospective database analysis of direct internal costs from a large health maintenance organization.
- Inclusion of published cost data for medically indicated postneonatal circumcisions.
- Study cohort comprised 14,893 male infants born in 1996, with sensitivity and Monte Carlo analyses.
Main Results:
- Postneonatal circumcision is significantly more expensive (10x) than neonatal circumcision ($1,921 vs $165).
- Medically indicated postneonatal circumcision was required for 9.6% of uncircumcised males.
- Cost benefits include prevention of urinary tract infections, balanoposthitis, phimosis, HIV, and penile cancer, with an estimated future healthcare cost offset of $183 per infant.
Conclusions:
- Neonatal circumcision provides multiple lifetime medical benefits at a low cost.
- The rate of postneonatal circumcision is the primary determinant of future cost savings.
- Early circumcision is a cost-effective strategy for maximizing health benefits and minimizing long-term healthcare expenditures.
Purpose:
We studied the costs of newborn circumcision in relation to its health benefits later in life.
Materials And Methods:
We conducted a retrospective database analysis using direct internal cost data from Kaiser Permanente Northern California-a large health maintenance organization-and published cost data (including the cost of medically indicated postneonatal circumcision). The study cohort consisted of 14,893 male infants born in 1996. One-way sensitivity analysis was used to demonstrate the impact of selected variables in the model. Monte Carlo analysis was used to determine the 95% confidence intervals.
Results:
Postneonatal circumcision was 10 times as expensive as neonatal circumcision (1,921 dollars per infant vs 165 dollars per newborn), and was medically indicated for 9.6% of uncircumcised males. Cost benefits of circumcision resulted from prevention of infant urinary tract infection, balanoposthitis, phimosis, HIV infection and penile cancer. Assuming initial neonatal circumcision cost to be 200 dollars, the future health care cost offset (avoided) was calculated as 183 dollars (range 93 dollars to 303 dollars in 95% of simulations).
Conclusions:
Multiple lifetime medical benefits of neonatal circumcision can be achieved at little or no cost. Because postneonatal circumcision is so expensive, its rate is the most important factor determining future cost savings from newborn circumcision.
