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

Loveleen Bansi-Matharu; Edinah Mudimu; Rowan Martin-Hughes; Matt Hamilton; Leigh Johnson; Debra Ten Brink; John Stover; Gesine Meyer-Rath; Sherrie L Kelly; Lise Jamieson; Valentina Cambiano; Andreas Jahn; Frances M Cowan; Collin Mangenah; Webster Mavhu; Thato Chidarikire; Carlos Toledo; Paul Revill; Maaya Sundaram; Karin Hatzold; Aisha Yansaneh; Tsitsi Apollo; Thoko Kalua; Owen Mugurungi; Valerian Kiggundu; Shufang Zhang; Rose Nyirenda; Andrew Phillips; Katharine Kripke; Anna Bershteyn

doi:10.1016/S2214-109X(22)00515-0

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

Loveleen Bansi-Matharu, Edinah Mudimu, Rowan Martin-Hughes, Matt Hamilton, Leigh Johnson, Debra Ten Brink, John Stover, Gesine Meyer-Rath, Sherrie L Kelly, Lise Jamieson, Valentina Cambiano, Andreas Jahn, Frances M Cowan, Collin Mangenah, Webster Mavhu, Thato Chidarikire, Carlos Toledo, Paul Revill, Maaya Sundaram, Karin HatzoldAisha Yansaneh, Tsitsi Apollo, Thoko Kalua, Owen Mugurungi, Valerian Kiggundu, Shufang Zhang, Rose Nyirenda, Andrew Phillips, Katharine Kripke, Anna Bershteyn

Centre for Health Economics

Research output: Contribution to journal › Article › peer-review

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 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.

Original language	English
Number of pages	12
Journal	The Lancet Global Health
Early online date	20 Dec 2022
DOIs	https://doi.org/10.1016/S2214-109X(22)00515-0
Publication status	E-pub ahead of print - 20 Dec 2022

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Cost-effectiveness of voluntary medical male circumcision for HIV prevention across sub-Saharan Africa: results from five independent models
© 2022 The Author(s)
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Bansi-Matharu, L., Mudimu, E., Martin-Hughes, R., Hamilton, M., Johnson, L., Ten Brink, D., Stover, J., Meyer-Rath, G., Kelly, S. L., Jamieson, L., Cambiano, V., Jahn, A., Cowan, F. M., Mangenah, C., Mavhu, W., Chidarikire, T., Toledo, C., Revill, P., Sundaram, M., ... Bershteyn, A. (2022). Cost-effectiveness of voluntary medical male circumcision for HIV prevention across sub-Saharan Africa: results from five independent models. The Lancet Global Health. Advance online publication. https://doi.org/10.1016/S2214-109X(22)00515-0

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

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 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.",

author = "Loveleen Bansi-Matharu and Edinah Mudimu and Rowan Martin-Hughes and Matt Hamilton and Leigh Johnson and {Ten Brink}, Debra and John Stover and Gesine Meyer-Rath and Kelly, {Sherrie L} and Lise Jamieson and Valentina Cambiano and Andreas Jahn and Cowan, {Frances M} and Collin Mangenah and Webster Mavhu and Thato Chidarikire and Carlos Toledo and Paul Revill and Maaya Sundaram and Karin Hatzold and Aisha Yansaneh and Tsitsi Apollo and Thoko Kalua and Owen Mugurungi and Valerian Kiggundu and Shufang Zhang and Rose Nyirenda and Andrew Phillips and Katharine Kripke and Anna Bershteyn",

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doi = "10.1016/S2214-109X(22)00515-0",

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Bansi-Matharu, L, Mudimu, E, Martin-Hughes, R, Hamilton, M, Johnson, L, Ten Brink, D, Stover, J, Meyer-Rath, G, Kelly, SL, Jamieson, L, Cambiano, V, Jahn, A, Cowan, FM, Mangenah, C, Mavhu, W, Chidarikire, T, Toledo, C, Revill, P, Sundaram, M, Hatzold, K, Yansaneh, A, Apollo, T, Kalua, T, Mugurungi, O, Kiggundu, V, Zhang, S, Nyirenda, R, Phillips, A, Kripke, K & Bershteyn, A 2022, 'Cost-effectiveness of voluntary medical male circumcision for HIV prevention across sub-Saharan Africa: results from five independent models', The Lancet Global Health. https://doi.org/10.1016/S2214-109X(22)00515-0

TY - JOUR

T1 - Cost-effectiveness of voluntary medical male circumcision for HIV prevention across sub-Saharan Africa

T2 - results from five independent models

AU - Bansi-Matharu, Loveleen

AU - Mudimu, Edinah

AU - Martin-Hughes, Rowan

AU - Hamilton, Matt

AU - Johnson, Leigh

AU - Ten Brink, Debra

AU - Stover, John

AU - Meyer-Rath, Gesine

AU - Kelly, Sherrie L

AU - Jamieson, Lise

AU - Cambiano, Valentina

AU - Jahn, Andreas

AU - Cowan, Frances M

AU - Mangenah, Collin

AU - Mavhu, Webster

AU - Chidarikire, Thato

AU - Toledo, Carlos

AU - Revill, Paul

AU - Sundaram, Maaya

AU - Hatzold, Karin

AU - Yansaneh, Aisha

AU - Apollo, Tsitsi

AU - Kalua, Thoko

AU - Mugurungi, Owen

AU - Kiggundu, Valerian

AU - Zhang, Shufang

AU - Nyirenda, Rose

AU - Phillips, Andrew

AU - Kripke, Katharine

AU - Bershteyn, Anna

PY - 2022/12/20

Y1 - 2022/12/20

N2 - 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.

AB - 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.

U2 - 10.1016/S2214-109X(22)00515-0

DO - 10.1016/S2214-109X(22)00515-0

M3 - Article

C2 - 36563699

SN - 2214-109X

JO - The Lancet Global Health

JF - The Lancet Global Health

ER -