The cost-utility analysis of adult male circumcision for prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa: a probabilistic decision model

Olalekan A Uthman, Taiwo Aderemi Popoola, Ismail Yahaya, Mubashir M B Uthman, Olatunde Aremu

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract


OBJECTIVE: The aim of this study was to assess the cost-utility of adult male circumcision (AMC) versus no AMC in the prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa.

METHODS: A decision tree was constructed and parameterized using data from published sources. The economic evaluation was conducted from the perspective of government health care payer. Benefits (disability adjusted life years [DALYs]) and costs were discounted at 3%. Costs were assessed in 2008 US dollars. One-way and probabilistic sensitivity analyses were conducted to assess the stability of the base-case results. The uncertainty surrounding the estimates of cost effectiveness was illustrated through a cost-effectiveness acceptability curve and cost-effectiveness plane.

RESULTS: In the base-case analysis, AMC can be regarded as cost saving because it is associated with higher DALYs gained and lower costs than no AMC. The probability that AMC is cost effective is above 0.96 at a threshold value of $150 and remains high over a wide range of threshold values. Thus, there is very little uncertainty surrounding the decision to adopt AMC for prevention of heterosexual acquisition of HIV in men. The results were found to be sensitive to varying any of the following parameters: DALYs averted, discount, and circumcision efficacy.

CONCLUSIONS: AMC is found to be cost saving. AMC may be seen as a promising new form of strategy for prevention of heterosexual acquisition of HIV in men, but should never replace other known methods of HIV prevention and should always be considered as part of a comprehensive HIV prevention package.

Original languageEnglish
Pages (from-to)70-79
Number of pages10
JournalValue in Health
Volume14
Issue number1
DOIs
Publication statusPublished - 4 Jan 2011

Fingerprint

Male Circumcision
Africa South of the Sahara
Heterosexuality
Statistical Models
Cost-Benefit Analysis
HIV
Costs and Cost Analysis
Quality-Adjusted Life Years
Uncertainty
Decision Trees
Information Storage and Retrieval
Delivery of Health Care

Keywords

  • cost-utility analysis
  • male circumcision
  • HIV/AIDS
  • probabilistic model
  • Sub-Saharan Africa

Cite this

The cost-utility analysis of adult male circumcision for prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa : a probabilistic decision model. / Uthman, Olalekan A; Popoola, Taiwo Aderemi; Yahaya, Ismail; Uthman, Mubashir M B; Aremu, Olatunde.

In: Value in Health, Vol. 14, No. 1, 04.01.2011, p. 70-79.

Research output: Contribution to journalArticle

Uthman, Olalekan A ; Popoola, Taiwo Aderemi ; Yahaya, Ismail ; Uthman, Mubashir M B ; Aremu, Olatunde. / The cost-utility analysis of adult male circumcision for prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa : a probabilistic decision model. In: Value in Health. 2011 ; Vol. 14, No. 1. pp. 70-79.
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N2 - OBJECTIVE: The aim of this study was to assess the cost-utility of adult male circumcision (AMC) versus no AMC in the prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa. METHODS: A decision tree was constructed and parameterized using data from published sources. The economic evaluation was conducted from the perspective of government health care payer. Benefits (disability adjusted life years [DALYs]) and costs were discounted at 3%. Costs were assessed in 2008 US dollars. One-way and probabilistic sensitivity analyses were conducted to assess the stability of the base-case results. The uncertainty surrounding the estimates of cost effectiveness was illustrated through a cost-effectiveness acceptability curve and cost-effectiveness plane. RESULTS: In the base-case analysis, AMC can be regarded as cost saving because it is associated with higher DALYs gained and lower costs than no AMC. The probability that AMC is cost effective is above 0.96 at a threshold value of $150 and remains high over a wide range of threshold values. Thus, there is very little uncertainty surrounding the decision to adopt AMC for prevention of heterosexual acquisition of HIV in men. The results were found to be sensitive to varying any of the following parameters: DALYs averted, discount, and circumcision efficacy. CONCLUSIONS: AMC is found to be cost saving. AMC may be seen as a promising new form of strategy for prevention of heterosexual acquisition of HIV in men, but should never replace other known methods of HIV prevention and should always be considered as part of a comprehensive HIV prevention package.

AB - OBJECTIVE: The aim of this study was to assess the cost-utility of adult male circumcision (AMC) versus no AMC in the prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa. METHODS: A decision tree was constructed and parameterized using data from published sources. The economic evaluation was conducted from the perspective of government health care payer. Benefits (disability adjusted life years [DALYs]) and costs were discounted at 3%. Costs were assessed in 2008 US dollars. One-way and probabilistic sensitivity analyses were conducted to assess the stability of the base-case results. The uncertainty surrounding the estimates of cost effectiveness was illustrated through a cost-effectiveness acceptability curve and cost-effectiveness plane. RESULTS: In the base-case analysis, AMC can be regarded as cost saving because it is associated with higher DALYs gained and lower costs than no AMC. The probability that AMC is cost effective is above 0.96 at a threshold value of $150 and remains high over a wide range of threshold values. Thus, there is very little uncertainty surrounding the decision to adopt AMC for prevention of heterosexual acquisition of HIV in men. The results were found to be sensitive to varying any of the following parameters: DALYs averted, discount, and circumcision efficacy. CONCLUSIONS: AMC is found to be cost saving. AMC may be seen as a promising new form of strategy for prevention of heterosexual acquisition of HIV in men, but should never replace other known methods of HIV prevention and should always be considered as part of a comprehensive HIV prevention package.

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