Costing Male Circumcision in Swaziland and Implications for the Cost-Effectiveness of Circumcision as an HIV Intervention
Clinical trials have now confirmed the efficacy of male circumcision (MC) in reducing female-to-male HIV transmission. Some cost data have been reported (ranging between US$25 and US$69) and these cost data also formed the basis of a cost-effectiveness analysis. It is unclear, however, what exactly is included in the costing studies and hence whether these costs are directly comparable. For example, often, indirect costs are not fully reflected; donations (especially clinicians’ time) are not costed; and variation by provider type and level of health facility is not considered. It is anticipated that this cost analysis will provide a more detailed examination of the costs of male circumcision and inform a sounder basis for an assessment of the cost-effectiveness of MC and planning for implementation of MC in Swaziland. This analysis is part of a larger study titled the “Costing Male Circumcision in Lesotho, Swaziland, and Zambia: Implications for Cost-Effectiveness of Circumcision as an HIV Intervention.” The larger study has two major components: (1) costing MC and (2) modeling the impact of MC on the HIV epidemic.
The purpose of the analysis in Swaziland was to (1) understand the social, cultural, and policy context of male circumcision; (2) assess the cost of providing adult MC in a resource-constrained setting; and (3) evaluate the implications of scaling up MC for the cost-effectiveness of MC and for the health system (e.g., resource mobilization and health system capacity).