Anderson Jonathan, Wilson David, Templeton David J, Grulich Andrew, Carter Robert, Kaldor John
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Darlinghurst, NSW 2010, Australia.
J Infect Dis. 2009 Dec 15;200(12):1803-12. doi: 10.1086/648472.
We examined the effects and cost-effectiveness of 4 strategies of circumcision in a resource-rich setting (Australia) in a population of men who have sex with men (MSM).
We created a dynamic mathematical transmission model and performed an economic analysis to estimate the costs, outcomes, and cost-effectiveness of different strategies, compared with those of the status quo. Strategies included circumcision of all MSM at age 18 years, circumcision of all MSM aged 35-44 years, circumcision of all insertive MSM aged 18 years, and circumcision of all MSM aged 18 years . All costs are reported in US dollars, with a cost-effectiveness threshold of $42,000 per quality-adjusted life-year.
We find that 2%-5% of human immunodeficiency virus (HIV) infections would be averted per year, with initial costs ranging from $3.6 million to $95.1 million, depending on the strategy. The number of circumcisions needed to prevent 1 HIV infection would range from 118 through 338. Circumcision of predominately insertive MSM would save $21.7 million over 25 years with a $62.2 million investment. Strategies to circumcise 100% of all MSM and to circumcise MSM aged 35-44 years would be cost-effective; the latter would require a smaller investment. The least cost-effective approach is circumcision of young MSM close to their sexual debut. Results are very sensitive to assumptions about the cost of circumcision, the efficacy of circumcision, sexual preferences, and behavioral disinhibition.
Circumcision of adult MSM may be cost-effective in this resource-rich setting. However, the intervention costs are high relative to the costs spent on other HIV prevention programs.
我们在资源丰富的环境（澳大利亚）中，对男男性行为者（MSM）群体的4种包皮环切策略的效果和成本效益进行了研究。
我们创建了一个动态数学传播模型，并进行了经济分析，以估计不同策略与现状相比的成本、结果和成本效益。策略包括对所有18岁的男男性行为者进行包皮环切、对所有35 - 44岁的男男性行为者进行包皮环切、对所有18岁的插入式男男性行为者进行包皮环切以及对所有18岁的男男性行为者进行包皮环切。所有成本均以美元报告，成本效益阈值为每质量调整生命年42,000美元。
我们发现，每年可避免感染2% - 5%的人类免疫缺陷病毒（HIV），初始成本从360万美元到9510万美元不等，具体取决于策略。预防1例HIV感染所需的包皮环切手术数量在118至338例之间。主要对插入式男男性行为者进行包皮环切，在25年内将节省2170万美元，投资为6220万美元。对所有男男性行为者进行100%包皮环切以及对35 - 44岁的男男性行为者进行包皮环切的策略具有成本效益；后者所需投资较小。最不具成本效益的方法是在男男性行为者性初次接触时对年轻男男性行为者进行包皮环切。结果对包皮环切成本、包皮环切效果、性偏好和行为抑制解除等假设非常敏感。
在这种资源丰富的环境中，成年男男性行为者进行包皮环切可能具有成本效益。然而，与其他HIV预防项目的成本相比，干预成本较高。
