Reach and Cost-Effectiveness of the PrePex Device for Safe Male Circumcision in Uganda
Reach and Cost-Effectiveness of the PrePex Device for Safe Male Circumcision in Uganda
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DOI：
10.1371/journal.pone.0063134
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发表时间：
2013-05-22
期刊：
影响因子：
3.7
通讯作者：
Coutinho, Alex
中科院分区：
文献类型：
--
作者：
Duffy, Kevin;Galukande, Moses;Coutinho, Alex
简介：2011年，在美国国际开发署卫生政策倡议和联合国艾滋病规划署的支持下进行的建模表明，乌干达需要进行420万次医疗男性包皮环切术，以达到80%的流行率。自2010年以来，乌干达已经完成了380，000例包皮环切术，并设定了2013年100万例的国家目标。目的：评估PrePex与当前外科SMC方法相比的相对范围和成本效益，并确定这可能有助于实现乌干达国家SMC目标的效果。2012年8月至10月在坎帕拉国际医院进行的为期10周的横断面描述性成本分析研究。将使用PrePex进行625例包皮环切术期间收集的数据与之前在同一地点使用手术包皮环切术方法从10，000例包皮环切术中收集的数据进行比较。结果：使用PrePex器械的中度不良事件（AE）发生率为2%，未发生重度不良事件，与手术方法相当，因此AE发生率对PrePex的可达性和成本-效果没有影响。使用PrePex进行一次包皮环切术的单位成本为30.55美元，比目前的手术方法高出35%（7.90美元），但PrePex方法将操作者效率提高了60%，这意味着一个团队可以完成24次包皮环切术，而手术方法为15次。PrePex的成本效益，比较进行包皮环切术的成本与未来可能避免HIV感染的成本节约，仅比目前的手术方法低2%，设备成本价格为20美元。结论：PrePex是一种可行的SMC放大工具，具有无与伦比的上级覆盖潜力，然而，只有有效地创造需求和提供训练有素人力资源，才能实现国家目标。
Introduction: Modelling, supported by the USAID Health Policy Initiative and UNAIDS, performed in 2011, indicated that Uganda would need to perform 4.2 million medical male circumcisions (MMCs) to reach 80% prevalence. Since 2010 Uganda has completed 380,000 circumcisions, and has set a national target of 1 million for 2013.Objective: To evaluate the relative reach and cost-effectiveness of PrePex compared to the current surgical SMC method and to determine the effect that this might have in helping to achieve the Uganda national SMC targets.Methods: A cross-sectional descriptive cost-analysis study conducted at International Hospital Kampala over ten weeks from August to October 2012. Data collected during the performance of 625 circumcisions using PrePex was compared to data previously collected from 10,000 circumcisions using a surgical circumcision method at the same site. Ethical approval was obtained.Results: The moderate adverse events (AE) ratio when using the PrePex device was 2% and no severe adverse events were encountered, which is comparable to the surgical method, thus the AE rate has no effect on the reach or cost-effectiveness of PrePex. The unit cost to perform one circumcision using PrePex is $30.55, 35% ($7.90) higher than the current surgical method, but the PrePex method improves operator efficiency by 60%, meaning that a team can perform 24 completed circumcisions compared to 15 by the surgical method. The cost-effectiveness of PrePex, comparing the cost of performing circumcisions to the future cost savings of potentially averted HIV infections, is just 2% less than the current surgical method, at a device cost price of $20.Conclusion: PrePex is a viable SMC tool for scale-up with unrivalled potential for superior reach, however national targets can only be met with effective demand creation and availability of trained human resource.