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南非 25-49 岁男性人群中增加对医疗男性割礼需求的干预措施的经济评价。

An economic evaluation of an intervention to increase demand for medical male circumcision among men aged 25-49 years in South Africa.

机构信息

Centers for Disease Control and Prevention, Atlanta, GA, USA.

Economics Department, Spelman College, 350 Spelman Lane, Atlanta, GA, 30314, USA.

出版信息

BMC Health Serv Res. 2021 Oct 15;21(1):1097. doi: 10.1186/s12913-021-06793-7.


DOI:10.1186/s12913-021-06793-7
PMID:34654429
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8520207/
Abstract

BACKGROUND: 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. OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: The intervention was cost-effective compared to similar MMC demand interventions and led to statistically significant cost savings per individual enrolled.

摘要

背景: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。

目的: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。

方法: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。

结果: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。

结论: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。

相似文献

[1]
An economic evaluation of an intervention to increase demand for medical male circumcision among men aged 25-49 years in South Africa.

BMC Health Serv Res. 2021-10-15

[2]
Cost and Impact of Voluntary Medical Male Circumcision in South Africa: Focusing the Program on Specific Age Groups and Provinces.

PLoS One. 2016-7-13

[3]
Male circumcision at different ages in Rwanda: a cost-effectiveness study.

PLoS Med. 2010-1-19

[4]
Effectiveness of an "Exclusive Intervention Strategy" to increase medical male circumcision uptake among men aged 25-49 years in South Africa.

BMC Public Health. 2018-7-13

[5]
Cost-effectiveness of male circumcision for HIV prevention in a South African setting.

PLoS Med. 2006-12

[6]
Voluntary medical male circumcision: modeling the impact and cost of expanding male circumcision for HIV prevention in eastern and southern Africa.

PLoS Med. 2011-11-29

[7]
Uptake and acceptability of medical male circumcision among young males in two culturally distinct settings in South Africa: A longitudinal, community-based study (the MACHO study).

S Afr Med J. 2020-9-30

[8]
Male circumcision for HIV prevention in sub-Saharan Africa: who, what and when?

AIDS. 2008-9-12

[9]
Effectiveness of and Financial Returns to Voluntary Medical Male Circumcision for HIV Prevention in South Africa: An Incremental Cost-Effectiveness Analysis.

PLoS Med. 2016-5-3

[10]
Voluntary medical male circumcision service delivery in South Africa: The economic costs and potential opportunity for private sector involvement.

PLoS One. 2018-12-17

本文引用的文献

[1]
Effectiveness of an "Exclusive Intervention Strategy" to increase medical male circumcision uptake among men aged 25-49 years in South Africa.

BMC Public Health. 2018-7-13

[2]
Cost and Cost-Effectiveness of a Demand Creation Intervention to Increase Uptake of Voluntary Medical Male Circumcision in Tanzania: Spending More to Spend Less.

J Acquir Immune Defic Syndr. 2018-7-1

[3]
The cost of demand creation activities and voluntary medical male circumcision targeting school-going adolescents in KwaZulu-Natal, South Africa.

PLoS One. 2017-6-20

[4]
Designing an optimal HIV programme for South Africa: Does the optimal package change when diminishing returns are considered?

BMC Public Health. 2017-1-31

[5]
Correction: The Cost of Voluntary Medical Male Circumcision in South Africa.

PLoS One. 2017-1-3

[6]
Cost and Impact of Voluntary Medical Male Circumcision in South Africa: Focusing the Program on Specific Age Groups and Provinces.

PLoS One. 2016-7-13

[7]
Effectiveness of and Financial Returns to Voluntary Medical Male Circumcision for HIV Prevention in South Africa: An Incremental Cost-Effectiveness Analysis.

PLoS Med. 2016-5-3

[8]
Cost drivers for voluntary medical male circumcision using primary source data from sub-Saharan Africa.

PLoS One. 2014-5-6

[9]
A novel Markov model projecting costs and outcomes of providing antiretroviral therapy to public patients in private practices versus public clinics in South Africa.

PLoS One. 2013-2-6

[10]
Voluntary medical male circumcision: modeling the impact and cost of expanding male circumcision for HIV prevention in eastern and southern Africa.

PLoS Med. 2011-11-29

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