Kahn JG et al. (2006) Cost-effectiveness of male circumcision for HIV prevention in a South African setting. PLoS Med 3: 2349–2358

Circumcised men are at reduced risk of acquiring HIV infection, but it is unclear whether this intervention is cost-effective compared with other HIV prevention strategies. Kahn and colleagues, therefore, created a cost-effectiveness model that assumed a stable HIV prevalence of 25.6% among adults. They incorporated data from the randomized, controlled, Orange Farm study performed in Gauteng Province, South Africa, in which adult male circumcision reduced the acquisition rate of new HIV infections by 60%.

The authors estimated that if 1,000 uninfected men underwent circumcision, 308 HIV infections would be averted over the following 20 years. The estimated cost of 1,000 circumcisions was US$55,724 (including procedural and publicity costs, and costs of treating adverse events). The cost of preventing one HIV infection was $181. If the lifetime medical costs of HIV treatment (conservatively estimated as $8,000 per patient) were taken into account, the estimated net cost saving achieved by each circumcision was $2,411.

The authors conclude that the moderate implementation costs, good protective effect, and savings in lifetime HIV care costs associated with male circumcision could contribute substantially to the restriction of HIV spread in sub-Saharan Africa—particularly in countries with low circumcision rates and high HIV prevalence. Even with less optimistic estimates than those used in this model for the cost and effectiveness of the intervention, and for HIV incidence, the net savings remain comparable to those achieved with other HIV prevention strategies. Counseling is, however, critical to avoid compensatory increases in risky behavior.