Centers for Disease Control and Prevention, Atlanta, GA, USA.
Economics Department, Spelman College, 350 Spelman Lane, Atlanta, GA, 30314, USA.
BMC Health Serv Res. 2021 Oct 15;21(1):1097. doi: 10.1186/s12913-021-06793-7.
Studies estimate that circumcising men between the ages of 20-30 years who have exhibited previous risky sexual behaviour could reduce overall HIV prevalence. Demand creation strategies for medical male circumcision (MMC) targeting men in this age group may significantly impact these prevalence rates.
The objective of this study is to evaluate the cost-effectiveness and cost-benefit of an implementation science, pre-post study designed to increase the uptake of male circumcision for ages 25-49 at a fixed MMC clinic located in Gauteng Province, South Africa.
A health care provider perspective was utilised to collect all costs. Costs were compared between the standard care scenario of routine outreach strategies and a full intervention strategy. Cost-effectiveness was measured as cost per mature man enrolled and cost per mature man circumcised. A cost-benefit analysis was employed by using the Bernoulli model to estimate the cases of HIV averted due to medical male circumcision (MMC), and subsequently translated to averted medical costs.
In the 2015 intervention, the cost of the intervention was $9445 for 722 men. The total HIV treatment costs averted due to the intervention were $542,491 from a public care model and $378,073 from a private care model. The benefit-cost ratio was 57.44 for the public care model and 40.03 for the private care model. The net savings of the intervention were $533,046 or $368,628 - depending on treatment in a public or private setting.
The intervention was cost-effective compared to similar MMC demand interventions and led to statistically significant cost savings per individual enrolled.
研究估计，对有过风险性行为的 20-30 岁男性进行割礼，可以降低总体艾滋病毒感染率。针对这一年龄段男性的医学男性割礼（MMC）需求创造策略可能会对这些流行率产生重大影响。
本研究的目的是评估一项实施科学的成本效益和成本效益，该研究旨在增加位于南非豪登省的一家固定 MMC 诊所对 25-49 岁男性的割礼率。
采用卫生保健提供者的视角收集所有成本。将标准护理方案（常规外展策略）和全面干预策略的成本进行比较。成本效益通过每成熟男性入组的成本和每成熟男性割礼的成本来衡量。采用伯努利模型进行成本效益分析，以估计因医学男性割礼（MMC）而避免的艾滋病毒病例数，并将其转化为避免的医疗费用。
在 2015 年的干预中，干预的成本为 722 名男性的 9445 美元。由于干预措施，从公共医疗模式中避免的艾滋病毒治疗总成本为 542491 美元，从私人医疗模式中避免的总成本为 378073 美元。公共医疗模式的效益成本比为 57.44，私人医疗模式的效益成本比为 40.03。干预的净储蓄为 533046 美元，或 368628 美元-取决于在公共或私人环境中进行治疗。
与类似的 MMC 需求干预措施相比，该干预措施具有成本效益，并导致每一个入组者的成本显著节省。
