Author Insights: Reducing Male Circumcision Rates Increases Health Care Costs

Aaron A. R. Tobian, MD, PhD, and colleagues at Johns Hopkins University suggest the decrease in male circumcision rates in the United States will lead to higher health care costs and rates of infection and certain infection-associated cancers. (Image: Johns Hopkins Pathology Photo)

Not providing coverage for male circumcision may save insurers money in the short-term, but such a policy may result in considerably higher costs in the long-term because uncircumcised individuals are more likely to acquire certain infections and cancers related to those infections, according to a study reported today in the Archives of Pediatrics & Adolescent Medicine by researchers from Johns Hopkins University in Baltimore.

Male circumcision rates have been decreasing in the United States, from about 79% of males born in the 1970s and 1980s to about 63% born in 1999 and about 55% born in 2010. The decline comes even as research has demonstrated that circumcision helps prevent certain serious infections. There are several reasons for the decline in circumcision rates, but one factor is decreased coverage by insurers and Medicaid.

To examine the financial costs and benefits related to circumcision, the researchers used a computer-based simulation model to estimate infection rates and costs in a US population that would occur if the male circumcision rate were reduced to 10%, the percentage seen in Europe. They estimated that HIV infections among men would increase by about 12%, herpes simplex virus type 2 infectious would increase by almost 20%, and high- and low-risk human papillomavirus (HPV) infections would increase by about 29% (high-risk HPV strains are associated with an increased risk of penile or cervical cancer). Women would also experience increased rates of infection. Lifetime health care costs would increase by about $400 for every male and $43 for every female.

Study coauthor Aaron A. R. Tobian, MD, PhD, an assistant professor of pathology, medicine, and epidemiology at Johns Hopkins, discusses his team’s findings:

“The medical evidence for the benefits of male circumcision is extremely clear. We now have 3 randomized controlled trials showing that male circumcision decreases HIV and genital herpes, as well as human papillomavirus, which causes penile cancer among men. One trial also followed female partners and found they also had reductions in levels of human papillomavirus.

“So we know the benefits of male circumcision, but we wanted to construct an economic model showing the consequences of not circumcising newborn males. If our male circumcision rate was to go down to 10%, the additional health care costs over a 10-year period would be $4.4 billion. And this is probably the most conservative estimate. This analysis focuses on direct medical costs alone, so there is nothing about other factors such as patient transportation costs and productivity loss.

“During the same time circumcision rates have fallen, state governments have been increasingly decreasing Medicaid coverage for male circumcision. One of the coauthors of an editorial that accompanied our study [Arleen A. Leibowitz, PhD] has previously shown there’s a correlation between a lack of Medicaid coverage and reduced numbers of infant circumcisions.

“The bottom line is we believe the federal Medicaid program should reclassify male circumcision from an optional service for states to cover to one that all state Medicaid programs should cover.”

Categories: HIV/AIDS, Men's Health, Neonatology and Infant Care, Sexually Transmitted Diseases