Cost-effectiveness of voluntary medical male circumcision (VMMC) for HIV prevention across sub-Saharan Africa: results from five independent models

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 ORCID: https://orcid.org/0000-0003-3087-4422, Mangenah, Colin, Mavhu, Webster ORCID: https://orcid.org/0000-0003-1881-4398, Hatzold, Karin, Yansaneh, Aisha, Apollo, Tsitsi, Kalua, Thoko, Mugurungi, Owen, Kiggundu, Valerian, Zhang, Shufang, Nyirenda, Rose, Phillips, Andrew, Kripke, Katharine and Bershteyn, Anna (2023) 'Cost-effectiveness of voluntary medical male circumcision (VMMC) for HIV prevention across sub-Saharan Africa: results from five independent models'. Lancet Global Health, Vol 11, Issue 2, e244-e255.

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Abstract

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 (ART) programmes, it is not clear whether VMMC still represents a cost-effective use of limited HIV programme resources.

Methods
Using five existing well-described HIV mathematical models, we compared continuation of VMMC for 5 years in males aged 15 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 (DALYs) 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 <0.1/100 person-years (py) in 15-49 year olds, increasing to 95% with HIV incidence >1.0/100py.

Interpretation
VMMC remains a cost-effective, often cost-saving, prevention intervention in sub-Saharan Africa for at least the next 5 years.

Item Type:	Article
Subjects:	WA Public Health > WA 30 Socioeconomic factors in public health (General) WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.6 Prevention and control WJ Urogenital System > WJ 20 Research (General)
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1016/S2214-109X(22)00515-0
Depositing User:	Rachel Dominguez
Date Deposited:	12 Jan 2023 14:10
Last Modified:	14 Jun 2023 11:36
URI:	https://archive.lstmed.ac.uk/id/eprint/21566

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