Drop in U.S. circumcisions could inflate health costs -study

NEW YORK Mon Aug 20, 2012 4:57pm EDT

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NEW YORK Aug 20 (Reuters Health) - If gaps in insurance coverage dramatically reduce the number of male babies being circumcised in the United States, related health costs could soar by several billion dollars, a new study suggests.

In as many as 18 U.S. states, the Medicaid health program for the poor has reduced funding for the procedure, which means fewer parents are opting to have their sons circumcised, according to Dr. Aaron Tobian and his colleagues from Johns Hopkins University in Baltimore.

His team calculated the future implications for U.S. health costs if that trend continues, and the results were published on Monday in the Archives of Pediatrics & Adolescent Medicine. bit.ly/KEGTVv

More than half of U.S. baby boys are circumcised today, but Tobian's team says that number could drop to as few as one in ten, in line with rates of circumcision in Europe, where the procedure is rarely covered by insurance.

Using a model based on studies of the long-term health effects of circumcision, they predicted that such a decline wo uld lead to more than double the rate of urinary tract infections in male babies and a 12 percent increase in the rate of HIV infections in men.

"The state governments think we can save a few bucks, but it ends up costing them more in the long run," Tobian told Reuters Health. "The medical benefits of male circumcision are extremely clear," he added, referring to reduced rates of HIV, penile cancer and herpes.

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

With a drop from the current circumcision rate of about 55 percent of baby boys 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, they said.

PREVENTING THE SPREAD OF DISEASE

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

The 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 (insurance) coverage of circumcision to be also increasing."

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. A new draft of that statement is set to be published next week.

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.

In Germany, a district court banned the practice for young boys, but said older consenting males could have the procedure, sparking an outcry among Muslim and Jewish groups. The country's parliament later upheld the right to religious circumcision. (Editing by Christine Soares and Michele Gershberg; desking by Andrew Hay)

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