Fewer circumcisions could cost billions

JOHNS HOPKINS (US) — Flagging rates of male circumcision could cost the US $4.4 billion more in health care expenses, researchers warn.

The researchers base their predictions on rates of male circumcision in the US continuing to drop over the next decade to levels like those already seen in Europe.


The added expense would stem from expected new cases and higher rates of sexually transmitted infections and related cancers among uncircumcised men and their female partners, according to the report in the Archives of Pediatrics & Adolescent Medicine.

A team of Johns Hopkins University disease experts and health economists says its cost analysis appears to be the first to account for increased rates of multiple infectious diseases associated with lower rates of male circumcision, including HIV/AIDS, herpes, and genital warts, and cervical and penile cancers.

Previous research focused mostly on HIV, the single most costly disease where risk of infection is decreased by male circumcision.

Roughly 55 percent of the 2 million boys born each year in the United States are circumcised, a decline from a high of 79 percent in the 1970s and 1980s, says epidemiologist and pathologist Aaron Tobian, leader of the study. Rates in Europe average 10 percent, and, in Denmark, only 1.6 percent of infant males undergo the procedure.

“Our economic evidence is backing up what our medical evidence has already shown to be perfectly clear,” says Tobian, an assistant professor in the Johns Hopkins University School of Medicine.

“There are health benefits to infant male circumcision in guarding against illness and disease, and declining male circumcision rates come at a severe price, not just in human suffering, but in billions of health care dollars as well.”

Circumcision removes foreskin at the tip of the penis, hindering the buildup of bacteria and viruses in the penis’ skin folds. The 20-year decline in the number of circumcised US baby boys has already cost the nation upwards of $2 billion, Tobian and his colleagues estimate.

Their analysis shows that, on average, each male circumcision not performed leads eventually to $313 more in illness-related expenses.

According to the analysis, if circumcision among men born in the same year dropped to European rates, there would be an expected 12 percent increase in men infected with HIV, 29 percent more men infected with human papillomavirus, a 19 percent increase in men infected with herpes simplex virus, and a 211 percent jump in the number of infant male urinary tract infections.

Among their female sex partners, there would be 50 percent more cases each of bacterial vaginosis and trichomoniasis. The number of new infections with the high-risk form of human papillomavirus, which is closely linked to cervical cancer in women, would increase by 18 percent.

State’s choices

State funding cuts in Medicaid, the government medical assistance program for the poor, have contributed substantially to the decline in US infant male circumcisions, Tobian says, noting that 18 states have stopped paying for the procedure.

“The financial and health consequences of these decisions are becoming worse over time, especially if more states continue on this ill-fated path,” he says. “State governments need to start recognizing the medical benefits as well as the cost savings from providing insurance coverage for infant male circumcision.”

The researchers built a new economic model to predict the cost implications of not circumcising a male newborn. Included was information from studies and databases that closely tracked the total number of people infected with each sexually transmitted disease and the numbers of new infections.

Costs were conservatively limited to direct costs for drug treatment, physician visits, and hospital care, and did not include indirect costs from work absences and medical travel expenses.

The most recent states to stop Medicaid funding for infant circumcision were Colorado and South Carolina in 2011.

Other states that do not fund circumcision through Medicaid are Arizona, California, Florida, Idaho Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, Nevada, North Carolina, North Dakota, Oregon, Utah, and Washington.

Source: Johns Hopkins University