To circ or not to circ: clinical and pharmacoeconomic outcomes of a prospective trial of topical steroid versus primary circumcision

Abstract

Purpose: To compare the efficacy and costs of circumcision versus topical treatment using a prospective pharmacoeconomic protocol. Materials and Methods:We treated 59 patients (3-10 years of age) randomized into two groups: 29 underwent an 8-week course of topical treatment with 0.2% betamethasone-hyaluronidase cream twice a day; and 30 underwent circumcision. Topical treatment success was defined as complete exposure of the glans. In cases of treatment failure, circumcision was performed and its cost imputed to that of the initial treatment. The pharmacoeconomic aspects were defined according to the Brazilian National Public Health System database and the Brazilian Community Pharmacies Index. Results: The two groups were statistically similar for all clinical parameters evaluated. Topical treatment resulted in complete exposure of the glans in 52% of the patients. Topical treatment was associated with preputial pain and hyperemia. However, treatment suspension was unnecessary. Minor complications were observed in 16.6% of the surgical group patients. The mean cost per patient was US$ 53.70 and US$ 125.20, respectively, for topical steroid treatment (including the costs related to treatment failure) and circumcision. The total costs were US$ 2,825.32 and US$ 3,885.73 for topical treatment and circumcision, respectively. Conclusions: Topical treatment of phimosis can reduce costs by 27.3% in comparison with circumcision. Therefore, topical treatment of phimosis should be considered prior to the decision to perform surgery.

Quality assessment of economic evaluation studies in pediatric surgery: A systematic review

“…At equivalent effectiveness, topical treatment of phimosis with topical corticosteroids was less expensive than circumcision ($58.31 vs $136 per child; p = 0.068) [58].…”

Abridged version: CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants

“…A recent metaanalysis and several RCT's show significant success (60-80%) when using topical steroid creams as a treatment modality for physiological phimosis [5][6][7][8][9] . Success rates are not dependent on steroid potency 10 .…”

Phimosis in Children

“…No significant side-effects were reported even in young patients [45]. Topical steroids are cheaper than circumcision by 27.4% [7, 54, 55]. They are also less harrowing and devoid of psychological trauma which is commonplace with circumcision [56].…”