A Cost-Utility Analysis of Neonatal Circumcision

Abstract

A cost-utility analysis, based on published data from multiple observational studies, comparing boys circumcised at birth and those not circumcised was undertaken using the Quality of Well-being Scale, a Markov analysis, the standard reference case, and a societal perspective. Neonatal circumcision increased incremental costs by $828.42 per patient and resulted in an incremental 15.30 well-years lost per 1000 males. If neonatal circumcision was cost-free, pain-free, and had no immediate complications, it was still more costly than not circumcising. Using sensitivity analysis, it was impossible to arrange a scenario that made neonatal circumcision cost-effective. Neonatal circumcision is not good health policy, and support for it as a medical procedure cannot be justified financially or medically.

The Economic Burden of Noncervical Human Papillomavirus Disease in the United States

“…Assuming two-thirds of all penile cancers are local at the time of diagnosis and the remaining one-third are advanced [16], we determined the discounted lifetime cost per case was $15,120. This estimate falls roughly midway between the two published estimates of $7,500 and $29,640, which we used as a plausible range [36,37].…”

“…We identified three publications with cost estimates for penile cancer [16,36,37]. Our base case estimate was developed from an Institute of Medicine (IOM) study of the costs and benefits of HPV vaccination [16].…”

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

“…The majority of the cost offset (50%) was by the cost of requiring a post-neonatal period circumcision and not the actual health benefits of a circumcision. In a contradictory study, by Van Howe, a cost utility analysis did not show circumcision to be cost effective on sensitivity analysis and on Monte Carlo simulation [222]. A recent study analyzed the impact of a reducing circumcision rate in the US on cost implications related to STI's and UTI [223].…”

Not a surgical vaccine: there is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia

“…Others have concluded that since the procedure both adds to health costs and reduces the overall health of the individual it can be justified on neither economic nor medical grounds. 62 Any consideration of the costs of circumcision will be woefully inadequate if it fails to factor in the value of the foreskin to the individual and the cost of surgical complications and other adverse sequelae, both physical and psychological.…”