The PrePex Device Is Unlikely to Achieve Cost-Savings Compared to the Forceps-Guided Method in Male Circumcision Programs in Sub-Saharan Africa

• Type of Material: Article
• Authors: Walter Obiero, Nyanza Reproductive Health Society; Marisa Young, Emory University; Robert C. Bailey, Nyanza Reproductive Health Society
• Language: English
• Date: 2013-01-21
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2013 Obiero et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0053380
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 8
• Issue: 1
• Start Page: e53380
• End Page: e53380
• Grant/Funding Information: WO is supported in part by CDC/PEPFAR.; The Nyanza Reproductive Health Society (NRHS), in partnership with the Kenyan MOH, is supported by CDC/PEPFARin carrying out provision of male circumcision services for HIV prevention.; MRY is supported by the University of Illinois at Chicago.; RCB is supported in part by the Chicago Developmental Center for AIDS Research (D-CFAR), an NIH funded program (P30 AI 082151).
• Keywords: Africa South of the Sahara; Cost Savings; Child; Surgical Instruments; HIV Infections; Male; Humans; Adolescent; Circumcision, Male
• Research Categories: Health Sciences, Public Health

Abstract

Background: Male circumcision (MC) reduces the risk of heterosexual HIV acquisition in men by approximately 60%. MC programs for HIV prevention are currently being scaled-up in fourteen countries in sub-Saharan Africa. The current standard surgical technique for MC in many sub-Saharan African countries is the forceps-guided male circumcision (FGMC) method. The PrePex male circumcision (PMC) method could replace FGMC and potentially reduce MC programming costs. We compared the potential costs of introducing the PrePex device into MC programming to the cost of the forceps-guided method. Methods: Data were obtained from the Nyanza Reproductive Health Society (NRHS), an MC service delivery organization in Kenya, and from the Kenya Ministry of Health. Analyses are based on 48,265 MC procedures performed in four Districts in western Kenya from 2009 through 2011. Data were entered into the WHO/UNAIDS Decision Makers Program Planning Tool. The tool assesses direct and indirect costs of MC programming. Various sensitivity analyses were performed. Costs were discounted at an annual rate of 6% and are presented in United States Dollars. Results: Not including the costs of the PrePex device or referral costs for men with phimosis/tight foreskin, the costs of one MC surgery were $44.54-$49.02 and $54.52-$55.29 for PMC and FGMC, respectively. Conclusion: The PrePex device is unlikely to result in significant cost-savings in comparison to the forceps-guided method. MC programmers should target other aspects of the male circumcision minimum package for improved cost efficiency.