Fewer Circumcisions May Increase Infections and Costs

Higher infection prevalence and medical costs estimated for both men and women

WEDNESDAY, Aug. 22 (HealthDay News) -- The reduced rate of neonatal male circumcision (MC) procedures performed in the United States is estimated to lead to increased infection prevalence and higher medical costs for men and women, according to a study published online Aug. 20 in the Archives of Pediatrics & Adolescent Medicine.

Noting that MC rates have decreased during the past 20 years, Seema Kacker, of the Bloomberg School of Public Health at Johns Hopkins University in Baltimore, and colleagues conducted a cost-effectiveness analysis using a Monte Carlo simulation to evaluate the expected change in the prevalence of MC-reduced infections and associated health care costs.

The researchers found that reduction of the MC rate to 10 percent would correlate with an increase in lifetime health care costs of $407 per male and $43 per female. There would be 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. For men, the prevalence of HIV, high- and low-risk human papillomavirus, herpes simplex virus, and infant urinary tract infections would be expected to increase, with HIV infections accounting for 78.9 percent of increased expenses. For females, there would be an expected increase in bacterial vaginosis, trichomoniasis, and high- and low-risk human papillomavirus 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 authors write. "It is imperative to consider these results and their implications in establishing future health care policies related to MC."

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