Declining rates of US infant male circumcision could add billions to health care costs

A team of disease experts and health economists at Johns Hopkins warns that steadily declining rates of U.S. infant male circumcision could add more than $4.4 billion in avoidable health care costs if rates over the next decade drop to levels now seen in Europe.

In a report to be published in the Archives of Pediatrics & Adolescent Medicine online Aug. 20, the Johns Hopkins experts say the added expense stems from new cases and higher rates of sexually transmitted infections and related cancers among uncircumcised men and their female partners. They say the study is believed to be the first cost analysis to account for increased rates of multiple infectious diseases associated with lower rates of , including HIV/AIDS, herpes and genital warts, as well as cervical and penile cancers. Previous research focused mostly on HIV, the single most costly disease whose risk of infection is decreased by male circumcision, a procedure that removes foreskin at the tip of the penis, hindering the buildup of bacteria and viruses in the penis' skin folds.

Senior study investigator, health epidemiologist and pathologist Aaron Tobian, M.D., Ph.D., says that roughly 55 percent of the 2 million males born each year in the United States are circumcised, a decline from a high of 79 percent in the 1970s and '80s. Rates in Europe average only 10 percent, and in Denmark, only 1.6 percent of infant males undergo the procedure.

"Our economic evidence is backing up what our medical evidence has already shown to be perfectly clear," says Tobian, an assistant professor at the Johns Hopkins University School of Medicine. "There are health benefits to infant male circumcision in guarding against illness and disease, and declining male circumcision rates come at a severe price, not just in human suffering, but in billions of health care dollars as well."

The 20-year decline in the number of American males circumcised at birth has already cost the nation upwards of $2 billion, Tobian and his colleagues estimate.

The Johns Hopkins team's analysis showed that, on average, each male circumcision passed over and not performed leads to $313 more in illness-related expenses, costs which Tobian says would not have been incurred if these men had undergone the procedure.

According to the team's analysis, if U.S. male circumcision rates among men born in the same year dropped to European rates, there would be an expected 12 percent increase in men infected with HIV (or 4,843); 29 percent more men infected with human papillomavirus (57,124); a 19 percent increase in men infected with herpes simplex virus (124,767); and a 211 percent jump in the number of infant male urinary tract infections (26,876). Among their female sex partners, there would be 50 percent more cases each of bacterial vaginosis (538,865) and trichomoniasis (64,585). The number of new infections with the high-risk form of human papillomavirus, which is closely linked to cervical cancer in women, would increase by 18 percent (33,148 more infections).

Tobian says state funding cuts in Medicaid, the government medical assistance program for the poor, have substantially reduced numbers of U.S. infant male circumcisions, noting that 18 states have stopped paying for the procedure. "The financial and health consequences of these decisions are becoming worse over time, especially if more states continue on this ill-fated path," he says. "State governments need to start recognizing the medical benefits as well as the cost savings from providing insurance coverage for infant male circumcision."

The problem in the United States is compounded, Tobian says, by the failure of the American Academy of Pediatrics to recognize the medical evidence in support of male circumcision.

The Johns Hopkins team says it plans to share its study findings among state government officials across the United States to help raise awareness of its medical and cost-benefit analysis.

In the study, researchers constructed a novel economic model to predict the cost implications of not circumcising a male newborn. Included in their forecasting was information from multiple studies and databases that closely tracked the number of overall infections for each sexually transmitted disease, as well as the numbers of new people infected. Costs were conservatively limited to direct costs for drug treatment, physician visits and hospital care, and did not include indirect costs from work absences and medical travel expenses.

The most recent states to stop Medicaid funding for infant circumcision were Colorado and South Carolina, in 2011. States that already had funding bans in place include Louisiana, Idaho and Minnesota, all since 2005; Maine, since 2004; Montana, Utah and Florida, since 2003; and Missouri, Arizona and North Carolina, since 2002. California, North Dakota, Oregon, Mississippi, Nevada and Washington – all stopped funding before 1999.

More information:
Arch Pediatr Adolesc Med. Published online August 20, 2012. doi:10.1001/archpediatrics.2012.1440
Arch Pediatr Adolesc Med. Published online August 20, 2012. doi:10.1001/archpediatrics.2012.1710

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ml66uk
3.9 / 5 (7) Aug 20, 2012
More misinformation by circumcised men. Despite almost no-one in Europe except for Jewish and Muslim families circumcising, Europe has lower rates of HIV.

Even in Africa (from a USAID report):
"There appears no clear pattern of association between male circumcision and HIV prevalencein 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher."

It is unclear if circumcised men are more likely to infect women. The only ever randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised.

Women have "skin folds" too, but we don't cut parts off baby girls. Think how much money we could save by removing their breast buds too (breast cancer affects about 12% of women, and kills about 3%).
Hugh7
4.2 / 5 (5) Aug 20, 2012
To suggest cutting parts off baby boys' genitals to prevent urinary tract infentions is absurd, when - by circumcision advocates' own figures - only one in 100 boys will ever suffer from them. The rest of the English-speaking world gave up mass-circumcision, with no outbreaks of any of the diseases it was supposed to be good against. A new study from Puetro Rico found circumcised men there were MORE likely to have STDS and HIV. A study in Uganda started to find that circumcising men INcreases the risk to women, but that was cut short for no good reason before that could be confirmed. Circumcision is a "cure" looking for a disease, an intervention in search of an excuse.

This story seems to be part of a concerted push to restore public funding to male genital cutting, lest the rate fall below 50%, the tipping point, when it will fall away to nothing.

Other studies have shown circumcision's risk and harm do NOT justify doing it. Why do they not get this level of publicity?
Andrew_Zacharuk
3.7 / 5 (3) Aug 20, 2012
the tipping point


I see what you did there!

I'm wondering how they figure lack of circumcision will increase the prevalence of HIV a whopping 12% when there are countries that already barely perform the procedure and yet have lower HIV rates than America. I also thought it was the general consensus that circumcision isn't realistic for preventing HIV except in areas in which the disease has reached pandemic proportions.
theskepticalpsychic
3 / 5 (2) Aug 21, 2012
It is not men who undergo circumcision under normal circumstances. It is infants, who are given no anesthetic as their genitals are cut into, with the presumption that they will be too young to remember the trauma. Circumcision is a barbaric ritual, and no, I am not anti-Semitic; just empathetic to a screaming infant's agony.
freethinking
3.7 / 5 (3) Aug 21, 2012
Trust experts. European experts are trying to stamp out circumcision, American experts are trying to get more boys cercumcised.

Even though I'm against circumcision and see no benifits, Let parents decide which set of experts to believe.
loneislander
3.7 / 5 (3) Aug 21, 2012
Any circumcision done without anesthetic (male or female) should be televised live so that the proper outrage of people will focus where it belongs.

rmsoran
3 / 5 (2) Aug 22, 2012
"The Johns Hopkins team's analysis showed that, on average, each male circumcision passed over and not performed leads to $313 more in illness-related expenses, costs which Tobian says would not have been incurred if these men had undergone the procedure."
---------> Each skipped male circumcision may cause an additional $ 313 in medical bills. Each circumcision costs between 500 to 2000 USD.
It's much cheaper to skip MC. And it leaves men with a much more pleasing sex experience due to 5000 more nervous endings in the prepuce. Most of the reported infections counted for by the Hopkins researcher is related to frequent switching of sex partners without use of condoms ...
Using consequently condoms, taking hygiene seriously and limiting sex to trustworthy partners would leave the medical bills at similar levels, regardless of MC.
rmsoran
1 / 5 (1) Aug 22, 2012
"The Johns Hopkins team's analysis showed that, on average, each male circumcision passed over and not performed leads to $313 more in illness-related expenses, costs which Tobian says would not have been incurred if these men had undergone the procedure."
---------> Each skipped male circumcision may cause an additional $ 313 in medical bills. Each circumcision costs between 500 to 2000 USD.
It's much cheaper to skip MC. And it leaves men with a much more pleasing sex experience due to 5000 more nervous endings in the prepuce. Most of the reported infections counted for by the Hopkins researcher is related to frequent switching of sex partners without use of condoms ...
Using consequently condoms, taking hygiene seriously and limiting sex to trustworthy partners would leave the medical bills at similar levels, regardless of MC.
PeterD
Aug 23, 2012
This comment has been removed by a moderator.
TheGhostofOtto1923
3.5 / 5 (19) Aug 25, 2012
"removes foreskin at the tip of the penis, hindering the buildup of bacteria and viruses in the penis' skin folds."

-I have to assume that the foreskin was selected for as it conveyed some evolutionary advantage... perhaps the reduction of infection in men and women? If men with foreskins were prone to infection, wouldnt it have disappeared long ago? Or is it vestigial? Or have microbes mutated to exploit it?
It is not men who undergo circumcision under normal circumstances. It is infants, who are given no anesthetic as their genitals are cut into, with the presumption that they will be too young to remember the trauma.
Right. So why cant it be an elected procedure, decided upon by men at risk, and performed safely and under anesthetic?

Anabaptists let people decide on baptism when they are old enough to do so. Why not circumcision? Moslem and jewish converts can already elect to do this for wholly idiot religionist reasons.

Seems to me this would save money in 2 ways?
Jeddy_Mctedder
1 / 5 (2) Aug 25, 2012
i'm a circumcised jew. this story is nonsense that is paid for publication by the lobbyists and pr paid firms by companies that sell and profit off of circumcision. every 'medical' procedure has its own lobby. the scandal about prostate exams----yes PROSTATE EXAMS----is that they are generally unecessary until an older age than was 'reccomended' and that the treatments for early stage prostate were totally unecessary and had been mandated and payed for over decades because of the great amount of profit that was made and then used by the lobbyists to persuade for more and more diagnosis and treatment.

this pattern---of fidning a profiteable 'sickness' =--and then lobbying for more diagnosis and then treatment at great reimbursement is a major reason medicare is so expensive.
find "make work' and lobby for more it. find 'paperwork' to be done and mandate more of it.

medicare needs to be gutted , and this can be done by socializing it to a single payer system.

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