Decline in circumcisions may increase infections and costs

Decline in circumcisions may increase infections and costs
Decline in circumcisions may increase infections and costs

HealthDay News -- Reductions in the rates of neonatal male circumcision (MC) procedures performed in the United States has lead to increased infection prevalence and higher medical costs for men and women, researchers found.

MC rates have decreased from 64.1% in 1995 to 55.9% in 2008. To examine the effect of these decreases on infection rates and health-care costs Aaron A. R. Tobian, MD, PhD, of the Bloomberg School of Public Health at Johns Hopkins University in Baltimore, and colleagues conducted a cost-effectiveness analysis.

A 10% reduction in the MC rate correlates with an increase in lifetime health care costs of $407 per male and $43 per female, they reported in the Archives of Pediatrics & Adolescent Medicine.

This correlates with an expected increase of $505 million in net expenditure per annual birth cohort, representing an increase of $313 per MC not performed. The net present value of additional costs would exceed $4.4 billion over 10 annual cohorts, the researchers found.

In addition to costs, infection rates would also climb. Among men, the researchers estimated a 12% increase in the prevalence of HIV, a 29% increase in high- and low-risk HPV, a 20% increase in herpes simplex virus type 2 and a 212% increase in infant urinary tract infections. The increases in HIV infections would account for the majority of increased expenses, at 78.9%.

Among females, the researchers estimated a 50% increase in lifetime incidence of bacterial vaginosis and trichomoniasis and an 18% increase in oncogenic HPV infections.

"Predictions based on this model's outcomes and the heterogeneous distribution of infection burden and MC prevalence are concerning, and further study may be warranted," the researchers wrote. "It is imperative to consider these results and their implications in establishing future health-care policies related to MC."

In an accompanying editorial, Arleen A. Leibowitz, PhD, and Katherine Desmond, MS, of the University of California, Los Angeles, suggest the study findings provide compelling evidence in favor of MC.

"[I]t is now time for the federal Medicaid program to consider reclassifying MC from an ‘optional' service to one that all state Medicaid plans will cover for those parents who choose the procedure for their newborn sons," they wrote.

Doing so would assure that states facing budgetary pressures do not drop MC as an optional service, and would thereby reduce future incidence of HIV and other STIs, as well as treatment costs.


References

  1. Kacker S et al. Arch Pediatr Adolesc Med. 2012; doi:10.1001/archpediatrics.2012.144.
  2. Leibowitz AA et al. Arch Pediatr Adolesc Med. 2012; doi:10.1001/archpediatrics.2012.1710.
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