| NEW YORK
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
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
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