222570 Cost Effectiveness of Male Circumcision for the Prevention of HIV at High Prevalence STD Clinics in Andhra Pradesh, India

Wednesday, November 10, 2010

Elizabeth Glaser, MS IHPM, 1st yr doctoral student , Heller School for Social Policy and Managment, Brandeis University, Waltham, MA
Background: Recent clinical trials in sub-Saharan Africa have established that adult male circumcision (MC) is protective and cost-effective against male acquisition of HIV through heterosexual intercourse. Few studies have examined the cost effectiveness of MC in countries beyond Africa. We adapt Kahn's model (2006) to analyze the potential effectiveness of MC in a high prevalence population in Andhra Pradesh, India. Methods: In Monte Carlo simulations, we evaluated cost effectiveness of 1000 MC procedures for men attending STD clinics in Andhra Pradesh. Data was derived from 2008 HIV prevalence estimates in India; effectiveness estimates were based on mean results from published trials in sub-Saharan Africa. Effectiveness was evaluated in discounted HIV infections averted (HIA) over 20 years at differing cost, prevalence, incentives and epidemic multiplier. Threshold analysis was used to determine cost benefits of MC compared to the lifetime medical cost of HIV. Results: For those attending an STD clinic in Andhra Pradesh, assuming effectiveness of 60% for MC, an STD clinic prevalence of 24.4%, procedural costs in government clinics, 1,000 circumcisions would avert an estimated 202 (discounted) HIV infections over 20 years. For the base case, cost per discounted HIA was estimated as $145 with a net saving of approximately $160,000. Conclusions: While MC may not be cost effective for all populations at risk for HIV, the result of this analysis demonstrates that it may provide a relatively safe, reliable, cost-effective method for reducing acquisition of HIV in a high-prevalence population in a lower middle income country such as India.

Learning Areas:
Biostatistics, economics
Protection of the public in relation to communicable diseases including prevention or control
Public health or related research

Learning Objectives:
1. Evaluate the cost effectiveness of male circumcision for prevention of HIV infection in a high prevalence population in India. 2.Demonstrate adaptation of the Kahn model, used previously in sub-Saharan Africa, for cost effectiveness analysis in another setting. 3.List the factors required for a cost effectiveness analysis of male circumcision for HIV prevention.

Keywords: Cost-Effectiveness, HIV Interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a doctoral student in Social Policy, Global Health and Development with an MS in International Health Policy and 17 years of nursing and mentoring in HIV/AIDS care. Issues in the integration of effective HIV care, prevention and policy will be the focus of my dissertation, and thus I am well versed in the area.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.