Research Article: Male Circumcision at Different Ages in Rwanda: A Cost-Effectiveness Study

Date Published: January 19, 2010

Publisher: Public Library of Science

Author(s): Agnes Binagwaho, Elisabetta Pegurri, Jane Muita, Stefano Bertozzi, Seth C. Kalichman

Abstract: Agnes Binagwaho and colleagues predict that circumcision of newborn boys would be effective and cost-saving as a long-term strategy to prevent HIV in Rwanda.

Partial Text: Male circumcision (MC) is one of the oldest and most common surgical procedures with approximately 30% of men circumcised worldwide [1]. While MC is almost universal in North Africa and most of West Africa, it is less common in Southern Africa where HIV prevalence is much higher. In Rwanda, MC is not a traditional procedure and it is estimated that only about 15% [2] of men are circumcised. Nonetheless, due to the ongoing debate about MC in the country, demand for the service is increasing (Ministry of Health [MOH], Rwanda).

The analysis adopts the perspective of the Government of Rwanda as a health care payer. In the absence of available tools to evaluate the impact of neonatal, adolescent, and adult MC, a basic cost-effectiveness model was developed. Calculations refer to an average Rwandan adolescent or adult male, and reflect risk factors for HIV such as age at first intercourse and presence of STIs, as well as sexual behaviours such as condom use and number/concurrency of partners.

Infant MC can lower health system costs because of moderate implementation costs, high and durable protective effects, and the averted HIV-care costs. As the sensitivity analysis shows, these findings are robust across a wide range of input values for Rwanda. The study shows that adolescent MC may be a highly cost-effective intervention. MC for adults is the least cost-effective of the three procedures.



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