Procedure linked to prevention of sexually transmitted infections and related cancers
A team of disease experts and health economists at Johns Hopkins warns that steadily declining rates of U.S. infant male circumcision could add more than $4.4 billion in avoidable health care costs if rates over the next decade drop to levels now seen in Europe.
In a report to be published in theArchives of Pediatrics & Adolescent Medicineonline Aug. 20, the Johns Hopkins experts say the added expense stems from new cases and higher rates of sexually transmitted infections and related cancers among uncircumcised men and their female partners. They say the study is believed to be the first cost analysis to account for increased rates of multiple infectious diseases associated with lower rates of male circumcision, including HIV/AIDS, herpes and genital warts, as well as cervical and penile cancers. Previous research focused mostly on HIV, the single most costly disease whose risk of infection is decreased by male circumcision, a procedure that removes foreskin at the tip of the penis, hindering the buildup of bacteria and viruses in the penis’ skin folds.
Senior study investigator, health epidemiologist and pathologist Aaron Tobian, M.D., Ph.D., says that roughly 55 percent of the 2 million males born each year in the United States are circumcised, a decline from a high of 79 percent in the 1970s and ‘80s. Rates in Europe average only 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 at 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.”
The 20-year decline in the number of American males circumcised at birth has already cost the nation upwards of $2 billion, Tobian and his colleagues estimate.
The Johns Hopkins team’s analysis showed that, on average, each male circumcision passed over and not performed leads to $313 more in illness-related expenses, costs which Tobian says would not have been incurred if these men had undergone the procedure.
According to the team’s analysis, if U.S. male circumcision rates among men born in the same year dropped to European rates, there would be an expected 12 percent increase in men infected with HIV (or 4,843); 29 percent more men infected with human papillomavirus (57,124); a 19 percent increase in men infected with herpes simplex virus (124,767); and a 211 percent jump in the number of infant male urinary tract infections (26,876). Among their female sex partners, there would be 50 percent more cases each of bacterial vaginosis (538,865) and trichom*oniasis (64,585). 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 (33,148 more infections).
Tobian says state funding cuts in Medicaid, the government medical assistance program for the poor, have substantially reduced numbers of U.S. infant male circumcisions, 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 problem in the United States is compounded, Tobian says, by the failure of the American Academy of Pediatrics to recognize the medical evidence in support of male circumcision.
The Johns Hopkins team says it plans to share its study findings among state government officials across the United States to help raise awareness of its medical and cost-benefit analysis.
In the study, researchers constructed a novel economic model to predict the cost implications of not circumcising a male newborn. Included in their forecasting was information from multiple studies and databases that closely tracked the number of overall infections for each sexually transmitted disease, as well as the numbers of new people infected. 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. States that already had funding bans in place include Louisiana, Idaho and Minnesota, all since 2005; Maine, since 2004; Montana, Utah and Florida, since 2003; and Missouri, Arizona and North Carolina, since 2002. California, North Dakota, Oregon, Mississippi, Nevada and Washington – all stopped funding before 1999.
Funding support for the study was provided by The Johns Hopkins Hospital. Other Johns Hopkins investigators involved in this research were Seema Kacker, B.S.; Kevin Frick, Ph.D.; and Charlotte Gaydos, M.S., Dr.P.H.
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Certainly! The article delves into the impact of declining rates of infant male circumcision in the United States and its potential consequences on health care costs and the spread of sexually transmitted infections (STIs) and related cancers. I'll break down the concepts covered in the article:
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Infant Male Circumcision: This is a surgical procedure that involves the removal of the foreskin at the tip of the penis. The article highlights its role in reducing the risk of infections and diseases, including HIV/AIDS, herpes, genital warts, cervical and penile cancers.
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Health Economics and Cost Analysis: The experts from Johns Hopkins conducted a cost analysis that estimates the economic implications of reduced circumcision rates. They projected the potential health care costs associated with increased cases of STIs and related diseases due to declining circumcision rates.
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Sexually Transmitted Infections (STIs): The article emphasizes the link between declining circumcision rates and the increased risk of STIs such as HIV/AIDS, herpes simplex virus, human papillomavirus (HPV), bacterial vaginosis, and trichom*oniasis among both men and their female partners.
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Health Consequences: It's highlighted that for each male circumcision not performed, there's an estimated increase in illness-related expenses, leading to billions in avoidable health care costs.
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Medicaid Funding and State Policies: The article discusses how funding cuts in Medicaid, particularly in certain states, have led to reduced rates of infant male circumcisions. It highlights the financial and health consequences of these decisions and urges state governments to recognize the medical benefits and cost savings associated with circumcision.
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Research Methodology: The Johns Hopkins team used a novel economic model that factored in data from various studies and databases to predict the cost implications of not performing circumcision on male newborns.
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Advocacy and Future Plans: The experts plan to disseminate their findings to raise awareness among state government officials about the medical and cost-benefit analysis associated with infant male circumcision.
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Study Contributors and Funding: The research team from Johns Hopkins includes experts in epidemiology, health economics, and pathology. Funding for the study was provided by The Johns Hopkins Hospital.
The study's key message revolves around the potential health and economic impacts of declining circumcision rates and aims to advocate for policy changes and awareness to mitigate these consequences.
