Cost-effectiveness of voluntary medical male circumcision for HIV prevention across sub-Saharan Africa: results from five independent models. Issue 2 (February 2023)

• Record Type: Journal Article
• Authors: Bansi-Matharu, Loveleen; Mudimu, Edinah; Martin-Hughes, Rowan; Hamilton, Matt; Johnson, Leigh; ten Brink, Debra; Stover, John; Meyer-Rath, Gesine; Kelly, Sherrie L; Jamieson, Lise; Cambiano, Valentina; Jahn, Andreas; Cowan, Frances M; Mangenah, Collin; Mavhu, Webster; Chidarikire, Thato; Toledo, Carlos; Revill, Paul; Sundaram, Maaya; Hatzold, Karin; Yansaneh, Aisha; Apollo, Tsitsi; Kalua, Thoko; Mugurungi, Owen; Kiggundu, Valerian; Zhang, Shufang; Nyirenda, Rose; Phillips, Andrew; Kripke, Katharine; Bershteyn, Anna
• Is Part Of: Lancet. Volume 11:Issue 2(2023)
• Page Start: e244
• Page End: e255
• Publication Date: 2023-02
• Subjects: World health -- Periodicals; 362.105
• DOI: 10.1016/S2214-109X(22)00515-0
• Languages: English
• ISSNs: 2214-109X

Abstract

Summary: Background: Voluntary medical male circumcision (VMMC) has been a recommended HIV prevention strategy in sub-Saharan Africa since 2007, particularly in countries with high HIV prevalence. However, given the scale-up of antiretroviral therapy programmes, it is not clear whether VMMC still represents a cost-effective use of scarce HIV programme resources. Methods: Using five existing well described HIV mathematical models, we compared continuation of VMMC for 5 years in men aged 15 years and older to no further VMMC in South Africa, Malawi, and Zimbabwe and across a range of setting scenarios in sub-Saharan Africa. Outputs were based on a 50-year time horizon, VMMC cost was assumed to be US$90, and a cost-effectiveness threshold of US$500 was used. Findings: In South Africa and Malawi, the continuation of VMMC for 5 years resulted in cost savings and health benefits (infections and disability-adjusted life-years averted) according to all models. Of the two models modelling Zimbabwe, the continuation of VMMC for 5 years resulted in cost savings and health benefits by one model but was not as cost-effective according to the other model. Continuation of VMMC was cost-effective in 68% of setting scenarios across sub-Saharan Africa. VMMC was more likely to be cost-effective in modelled settings with higher HIV incidence; VMMC was cost-effective in 62% of settings with HIV incidence of less than 0·1 per 100 person-years in men aged 15–49 years, increasing to 95% with HIV incidence greater than 1·0 per 100 person-years. Interpretation: VMMC remains a cost-effective, often cost-saving, prevention intervention in sub-Saharan Africa for at least the next 5 years. Funding: Bill & Melinda Gates Foundation for the HIV Modelling Consortium.