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

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.

Informations de copyright

Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests LB-M has received support for the present manuscript paid to his institution from the Bill & Melinda Gates Foundation (BMGF). AB has received grants or contracts from the US National Institutes of Health and Foundation for Innovative New Diagnostics (FIND), and consulting fees from Gates Ventures. FMC has received grants or contracts paid to her institution from Wellcome Trust, BMGF, Medical Research Council (MRC), UNICEF, and UNITAID. GM-R has received support for the present manuscript paid to her institution from BMGF, and grants or contracts paid to her institution from National Institutes of Health, FIND, BMGF, and United States Agency for International Development (USAID). MH has received support for the present manuscript paid to his institution from BMGF. KK has received support for the present manuscript paid to her institution from BMGF and a grant from UNAIDS to support modelling activities not directly related to this manuscript. VC has received support for the present manuscript paid to her institution from BMGF and grants paid to her institution from the UK Research and Innovation, UNITAID, National Institute for Health Research, USAID, MRC, and BMGF. VC has received consulting fees from WHO. AP has received support for the present manuscript paid to his institution from BMGF. All other authors declare no competing interests.