As circumcision rates drop, costs increase: study

NEW YORK Mon Aug 20, 2012 4:09pm EDT

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NEW YORK (Reuters Health) - As gaps in insurance coverage lead to fewer male babies being circumcised in the United States, related health costs could end up increasing by millions of dollars every year, a new study suggests.

Using a model based on studies of the long-term health effects of circumcision, researchers predicted that the rate of urinary tract infections in male babies would more than double - and the rate of HIV infections in men increase by 12 percent - if only one in ten male newborns was circumcised nationwide.

More than half of U.S. baby boys are circumcised today, but a drop to one in ten is not entirely unlikely given that it's in line with rates of circumcision in Europe, where the procedure is rarely covered by insurance, according to Dr. Aaron Tobian and his colleagues from Johns Hopkins University in Baltimore.

Yet it is concerning, researchers said.

"The medical benefits of male circumcision are extremely clear," said Tobian - including reduced rates of HIV, penile cancer and herpes.

Still, Medicaid programs in more and more states have been cutting funding for the procedure, he told Reuters Health, which means fewer parents are opting to have their sons circumcised.

For the new study, Tobian's team wanted to predict the future implications for health costs in the U.S. if those cuts continue.

Each circumcision costs Medicaid or private insurers about $250 to $300, Tobian said. Still, the researchers predicted that each "forgone" circumcision would add a net $313 in costs, given the extra doctor's appointments, medication and other treatment for men who would contract HIV or human papillomavirus (HPV), for example, as a result of being uncircumcised.

With a drop from the current circumcision rate of about 55 percent of baby boys born in the U.S. to 10 percent, there would be almost 5,000 extra HIV cases in men, 57,000 extra HPV infections and another 27,000 newborn UTIs among about four million babies, they calculated.

Related costs would add up to more than $4.4 billion for babies born over a decade-long span, the researchers reported Monday in the Archives of Pediatrics & Adolescent Medicine.

Most of the data for the new model came from research done in Africa. But it's reasonable to assume those findings would apply to men in the U.S. as well, according to Helen Weiss, an epidemiologist who has studied circumcision at the London School of Hygiene & Tropical Medicine.

Foreskin is rich in HIV target cells, she told Reuters Health. Therefore a man without foreskin is less likely to contract HIV and some other sexually transmitted infections.

It's not clear whether circumcised men are also less likely to pass on the diseases to a partner if they are infected, said Weiss, who wasn't involved in the new study.

"But obviously at the population level, women are less likely to acquire it if there's less HIV in the male population," she added.

Less transmission of HPV also means women are at lower risk of cervical cancer, which is closely tied to the virus.

Weiss agreed that male newborn circumcision is "a very cost-effective intervention." It typically hasn't been popular in the UK and the rest of Europe outside of Muslim and Jewish families who circumcise their sons for religious reasons, she added.

She said evidence from the past five years especially supports the long-term health benefits of circumcision - which itself comes with a very low risk of infection in newborns.

"We seem to be finding more and more things that circumcision protects against," Weiss said. "If anything you would expect coverage of circumcision to be also increasing."

Yet in recent years, 18 states have eliminated funding for circumcision for their residents on Medicaid, the government insurance program for the poor.

"The state governments think we can save a few bucks (by dropping circumcision coverage), but it ends up costing them more in the long run," Tobian said.

The American Academy of Pediatrics' most recent statement on the issue, reaffirmed in 2005, said there is not enough evidence to recommend routine male newborn circumcision. But a new draft of that statement is set to be published next week, the AAP confirmed.

There are also ethical questions about whether it's okay to perform circumcision on a newborn boy who is obviously too young to consent, researchers noted. But as boys get older, the procedure becomes more complicated and expensive.

Tobian said both Medicaid and private insurers should cover circumcision, allowing all economic barriers to be eliminated, so the decision for or against it can be made based on discussions between parents and doctors.

SOURCE: bit.ly/KEGTVv Archives of Pediatrics & Adolescent Medicine, online August 20, 2012.

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