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Male circumcision at different ages in Rwanda: a cost-effectiveness study
Agnes Binagwaho1, Elisabetta Pegurri, Jane Muita
1Ministry of Health, Kigali, Rwanda. abinagwaho@gmail.com
Plos Medicine
|January 26, 2010
Summary
Neonatal male circumcision (MC) is the most cost-effective strategy for reducing HIV infections in Rwanda. Prioritizing infant MC offers significant long-term health benefits and cost savings for the healthcare system.
Area of Science:
- Public Health
- Health Economics
- Infectious Disease Epidemiology
Background:
- Male circumcision (MC) is proven to reduce HIV and STI transmission.
- Rwanda, with 3% HIV prevalence, is considering MC despite it not being a traditional practice.
- This study addresses the cost-effectiveness of MC in a low-prevalence (<5%) setting, focusing beyond adult circumcision.
Discussion:
- A cost-effectiveness model evaluated MC for newborns, adolescents, and adult men in Rwanda.
- Effectiveness was measured by averted HIV infections, considering incidence rates and MC's protective effect.
- Costs included procedures, training, counseling, adverse events, and adjusted for averted lifetime healthcare costs (ART, OI, lab tests).
Key Insights:
- Neonatal MC is highly cost-effective (US$3,932 per infection averted) and cost-saving, despite later savings realization.
- Adolescent MC is cost-effective (US$4,949 per infection averted) but less robust than infant MC.
- Adult MC is neither cost-saving nor highly cost-effective based on direct benefits alone.
Outlook:
- Rwanda should scale up MC across all age groups, prioritizing neonates.
- Infant MC integration into routine services (vaccinations) can achieve high coverage for maximal HIV reduction.
- Adolescent and adult MC can serve as initial 'catch-up' campaigns, becoming less critical with widespread infant MC.
