Estimating the Cost of Early Infant Male Circumcision in Zimbabwe: Results from a Randomized Noninferiority Trial of AccuCirc Device versus Mogen Clamp

Citation

Mangenah, Collin; Mavhu, Webster; Hatzold, Karin; Biddle, Andrea K.; Madidi, Ngonidzashe; Ncube, Getrude; Mugurungi, Owen; Ticklay, Ismail; Cowan, Frances M.; & Thirumurthy, Harsha (2015). Estimating the Cost of Early Infant Male Circumcision in Zimbabwe: Results from a Randomized Noninferiority Trial of AccuCirc Device versus Mogen Clamp. Journal of Acquired Immune Deficiency Syndromes, 69(5), 560-566. PMCID: PMC4508205

Abstract

BACKGROUND: Safe and cost-effective programs for implementing early infant male circumcision (EIMC) in Africa need to be piloted. We present results on a relative cost analysis within a randomized noninferiority trial of EIMC comparing the AccuCirc device with Mogen clamp in Zimbabwe.
METHODS: Between January-June 2013, male infants who met inclusion criteria were randomized to EIMC through either AccuCirc or Mogen clamp conducted by a doctor, using a 2:1 allocation ratio. We evaluated the overall unit cost plus the key cost drivers of EIMC using both AccuCirc and Mogen clamp. Direct costs included consumable and non-consumable supplies, device, personnel, associated staff training, and environmental costs. Indirect costs comprised capital and support personnel costs. In one-way sensitivity analyses, we assessed potential changes in unit costs due to variations in main parameters, one at a time, holding all other values constant.
RESULTS: The unit costs of EIMC using AccuCirc and Mogen clamp were $49.53 and $55.93, respectively. Key cost drivers were consumable supplies, capacity utilization, personnel costs, and device price. Unit prices are likely to be lowest at full capacity utilization and increase as capacity utilization decreases. Unit prices also fall with lower personnel salaries and increase with higher device prices.
CONCLUSIONS: EIMC has a lower unit cost when using AccuCirc compared to Mogen clamp. In order to minimize unit costs, countries planning to scale-up EIMC using AccuCirc need to control costs of consumables and personnel. There is also need to negotiate a reasonable device price, and maximize capacity utilization.

URL

http://dx.doi.org/10.1097/qai.0000000000000699

Reference Type

Journal Article

Year Published

2015

Journal Title

Journal of Acquired Immune Deficiency Syndromes

Author(s)

Mangenah, Collin
Mavhu, Webster
Hatzold, Karin
Biddle, Andrea K.
Madidi, Ngonidzashe
Ncube, Getrude
Mugurungi, Owen
Ticklay, Ismail
Cowan, Frances M.
Thirumurthy, Harsha

PMCID

PMC4508205

ORCiD

Thirumurthy - 0000-0002-3308-7603