Cost-effectiveness of voluntary medical male circumcision (VMMC) 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 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 (VMMC) 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 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

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

21 Citations (Scopus)

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.

Original language	English
Pages (from-to)	e244-e255
Journal	The Lancet Global Health
Volume	11
Issue number	2
Early online date	20 Dec 2022
DOIs	https://doi.org/10.1016/s2214-109x(22)00515-0
Publication status	Published - 1 Feb 2023

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PIIS2214109X22005150Final published version, 546 KBLicence: CC BY-NC-ND

Cite this

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., Mangenah, C., Mavhu, W., Chidarikire, T., Toledo, C., Revill, P., Sundaram, M., ... Bershteyn, A. (2023). Cost-effectiveness of voluntary medical male circumcision (VMMC) for HIV prevention across sub-Saharan Africa: results from five independent models. The Lancet Global Health, 11(2), e244-e255. https://doi.org/10.1016/s2214-109x(22)00515-0

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

abstract = "BackgroundVoluntary 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.MethodsUsing 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. FindingsIn 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.",

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 Frances Cowan 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",

language = "English",

volume = "11",

pages = "e244--e255",

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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, F , 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 2023, 'Cost-effectiveness of voluntary medical male circumcision (VMMC) for HIV prevention across sub-Saharan Africa: results from five independent models', The Lancet Global Health, vol. 11, no. 2, pp. e244-e255. https://doi.org/10.1016/s2214-109x(22)00515-0

TY - JOUR

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

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 - 2023/2/1

Y1 - 2023/2/1

N2 - BackgroundVoluntary 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.MethodsUsing 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. FindingsIn 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.

AB - BackgroundVoluntary 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.MethodsUsing 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. FindingsIn 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.

U2 - 10.1016/s2214-109x(22)00515-0

DO - 10.1016/s2214-109x(22)00515-0

M3 - Article

SN - 2572-116X

VL - 11

SP - e244-e255

JO - The Lancet Global Health

JF - The Lancet Global Health

IS - 2

ER -

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

Abstract

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