Kim Hae-Young, Lebina Limakatso, Milovanovic Minja, Taruberekera Noah, Dowdy David W, Martinson Neil A
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Glob Health Action. 2015 Dec 15;8:29116. doi: 10.3402/gha.v8.29116. eCollection 2015.
Several circumcision devices have been evaluated for a safe and simplified male circumcision among adults. The PrePex device was prequalified for voluntary male medical circumcision (VMMC) in May 2013 by the World Health Organization and is expected to simplify the procedure safely while reducing cost. South Africa is scaling up VMMC.
To evaluate the overall unit cost of VMMC at a mixed site vs. a hypothetical PrePex-only site in South Africa.
We evaluated the overall unit cost of VMMC at a mixed site where PrePex VMMC procedure was added to routine forceps-guided scalpel-based VMMC in Soweto, South Africa. We abstracted costs and then modeled these costs for a hypothetical PrePex-only site, at which 9,600 PrePex circumcisions per year could be done. We examined cost drivers and modeled costs, varying the price of the PrePex device. The healthcare system perspective was used.
In both sites, the main contributors of cost were personnel and consumables. If 10% of all VMMC were by PrePex at the mixed site, the overall costs of the surgical method and PrePex were similar - US$59.62 and $59.53, respectively. At the hypothetical PrePex-only site, the unit cost was US$51.10 with PrePex circumcisions having markedly lower personnel and biohazardous waste management costs. In sensitivity analysis with the cost of PrePex kit reduced to US$10 and $2, the cost of VMMC was further reduced.
Adding PrePex to an existing site did not necessarily reduce the overall costs of VMMC. However, starting a new PrePex-only site is feasible and may significantly reduce the overall cost by lowering both personnel and capital costs, thus being cost-effective in the long term. Achieving a lower cost for PrePex will be an important contributor to the scale-up of VMMC.
已对多种包皮环切器械进行评估，以实现成人男性包皮环切术的安全与简化。PrePex器械于2013年5月被世界卫生组织预认证用于自愿男性医学包皮环切术（VMMC），有望在降低成本的同时安全简化手术流程。南非正在扩大VMMC的实施规模。
评估南非一个混合手术点与一个假设的仅使用PrePex器械的手术点VMMC的总体单位成本。
我们评估了南非索韦托一个混合手术点VMMC的总体单位成本，该手术点在常规镊子引导下手术刀包皮环切术基础上增加了PrePex VMMC手术。我们提取成本数据，然后为一个假设的仅使用PrePex器械的手术点建立成本模型，该手术点每年可进行9600例PrePex包皮环切术。我们研究了成本驱动因素并建立成本模型，改变PrePex器械的价格。采用医疗保健系统视角。
在两个手术点，成本的主要构成部分都是人员和耗材。如果混合手术点所有VMMC的10%采用PrePex手术，手术方法和PrePex的总体成本相似，分别为59.62美元和59.53美元。在假设的仅使用PrePex器械的手术点，单位成本为51.10美元，PrePex包皮环切术的人员成本和生物危害废物管理成本显著更低。在敏感性分析中，当PrePex套件成本降至10美元和2美元时，VMMC成本进一步降低。
在现有手术点增加PrePex手术不一定能降低VMMC的总体成本。然而，开设一个新的仅使用PrePex器械的手术点是可行的，且可能通过降低人员和资本成本显著降低总体成本，因此从长期来看具有成本效益。降低PrePex的成本将是扩大VMMC实施规模的一个重要因素。
