Kacker, S., Frick, K.D., Quinn, T.C., et al. Sexually Transmitted Diseases (July 2013), Vol. 40 No. 7, pp. 559-568.
The authors modeled the short- and long-term financial implications of the scale-up of male circumcision (MC), taking into account infections shown to be averted by MC. They simulated four strategies with various rates and extents of MC scale-up, and compared the results with a baseline scenario of current MC prevalence and trends in Rakai District, Uganda. The strategies included a combination of gradual and rapid scale-up with either adolescents/adults (aged 15-49) only or including infants (aged 0-1). Cost savings from MC-related reduction in infections varied from US $197,531 after five years of scale-up focused on adolescents/adults, to US $13.7 million after 25 years with infant circumcision included. Including infants in MC strategies is more costly in the short term but achieves considerable savings long-term. Also, rapid scale-up of MC may lead to greater savings earlier, and over time, compared to gradual strategies, due to averted infections. Reduced HIV incidence accounted for approximately 46 percent of reductions in infection-related costs and 50 percent of cost savings; 79 percent of costs in five years; and 90 percent of cost savings in 25 years. The authors concluded that investment in MC strategies that incorporate both infants and adolescents/adults may have greater long-term impact than targeting the latter population only. The findings support health and economic benefits of MC scale-up.