Falling circumcision rate raises medical costs

The steadily declining rate of circumcision in US newborn boys could add more than $4.4 billion in avoidable health care costs for treating the increasing cases of sexually transmitted infections and related cancers among uncircumcised men and their women partners over the next decade, a new cost analysis has found.

Circumcision rates have fallen from about 79% in the 1970s and 1980s to 55% in 2010. During this period, 18 states have eliminated Medicaid coverage for circumcision of infant boys.

Researchers at Johns Hopkins used a novel economic model to predict the cost implications of not circumcising an infant boy. Only direct costs for drug therapy, physician visits, and hospital care were considered.

The analysis showed that if circumcision rates of US infant boys dropped from the current level to 10%, the average rate in Europe, lifetime medical costs for circumcision-reduced infections would increase by $407 for each man and by $43 for each woman. Net health care costs for each annual birth cohort would increase by more than $505 million, an increase of $313 for each foregone circumcision. Increased prevalence of HIV infection of men would represent nearly 80% of the increase in health care costs.

In a male birth cohort, there would be an expected 12% increase in the prevalence of HIV infection, a 29% increase in human papillomavirus infection, a 20% increase in herpes simplex virus infection, and a 212% increase in urinary tract infections in boys. Among women, there would be 51% more cases each of bacterial vaginosis and trichomoniasis. The number of new infections with the high-risk form of human papillomavirus, which is closely linked to cervical cancer, would increase by 18%.

A revised policy statement issued by the American Academy of Pediatrics does not recommend routine circumcision for all newborn boys but says that the benefits of the procedure outweigh the risks and that the decision should be left to the parents.

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