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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000422244.49965.e0
In the News

Study Evaluates Financial and Health Impacts of the Decline in U.S. Male Circumcision

Carter, David

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Abstract

But the controversy continues.

Although the prevalence of male circumcision remained stable during the 1970s and 1980s at approximately 79%, by 2010 the rate had decreased to 54.7%. This decline has occurred as state governments are eliminating Medicaid coverage for neonatal male circumcision: to date, 18 states have abolished such coverage. Private third-party carriers have also decreased coverage for this procedure. These decreases in coverage are likely to engender further decreases in the rates of male circumcision. In August, a study was published that evaluated the health and financial impact of the declining rates of male circumcision.

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Figure. Photo by Ric...
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The authors of the analysis state that there's growing evidence of the health benefits of male circumcision, citing three randomized controlled trials in Africa that found a correlation between male circumcision and lower risks of infection with HIV, low-risk and high-risk human papillomavirus (LR-HPV and HR-LPV), and herpes simplex virus type 2. One of the trials also demonstrated that female partners of circumcised men had lower rates of LR-HPV, HR-LPV, bacterial vaginosis, and trichomoniasis. Observational studies in the United States have found similar results and also suggest that circumcision confers some protection against urinary tract infections in male infants.

In the current study, researchers used a simulation model to predict the change in lifetime costs and infection prevalence correlated with the decreasing male circumcision rates. The conservative analysis took into account risks of all health conditions that have been shown to be significantly reduced by male circumcision but calculated only direct medical expenses.

The model projected that if the male circumcision rate fell to Europe's current level (10%), we would see lifetime increases in direct medical costs of $407 for each man and $43 for each woman related to infections shown to be reduced by male circumcision, or just under $916 million for each annual birth cohort. After adjusting this finding for the expense of the procedure and its complications, the net increase in health care costs would be $505 million annually.

On August 27, the American Academy of Pediatrics updated its policy on male circumcision, which now states that the “preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure.” The statement has stirred up controversy, particularly among critics who believe male circumcision causes pain, diminishes sexual pleasure, and impairs sexual function, among other adverse effects.—David Carter

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Reference

Kacker S, et al. Arch Pediatr Adolesc Med. 2012;Aug 20:e1–e9
[Epub ahead of print]; Task Force on Circumcision. Pediatrics. 2012;130(3):585–6

© 2012 Lippincott Williams & Wilkins, Inc.

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