Comparative Cost Analysis of Surgical and PrePex Device Male Circumcision in Zimbabwe and Mozambique.
Comparative Cost Analysis of Surgical and PrePex Device Male Circumcision in Zimbabwe and Mozambique.
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津巴布韦和莫桑比克手术和 PrePex 装置男性包皮环切术的成本比较分析。
DOI：
10.1097/qai.0000000000000797
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Hatzold,Karin
中科院分区：
文献类型：
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作者：
Schutte,Carl;Tshimanga,M;Mugurungi,Owen;Come,Iotamo;Necochea,Edgar;Mahomed,Mehebub;Xaba,Sinokuthemba;Bossemeyer,Debora;Ferreira,Thais;Macaringue,Lucinda;Chatikobo,Pessanai;Gundididza,Patricia;Hatzold,Karin
背景：PrePex设备已被证明对几个非洲国家的成年人进行自愿医用男性包皮环切术(VMMC)是安全的。成本计算研究是津巴布韦PrePex/手术比较研究和莫桑比克试点实施研究的一部分。方法：这些研究使用成本分析方法计算每个男性包皮环切的单位成本。计算了直接成本(消耗性和非消耗性用品、设备、人员、相关人员培训)和选定的间接成本(资本和支持人员成本)。结果：津巴布韦的成本比较显示，PrePex和手术的单位成本分别为45.50美元和53.08美元。单位费用差异是因为使用一次性器械包的外科手术的人员和消耗品供应费用较高。在莫桑比克，成本分析估计PrePex包皮环切术的单位成本(40.66美元)高于手术(20.85美元)，原因是消耗品成本较高，特别是PrePex设备，而使用可重复使用的器械的外科手术的消耗品成本较低。在莫桑比克，用品和直接人力成本占PrePex的87.2%，占手术单位成本的65.8%。讨论：在津巴布韦，PrePex男性包皮环切术可能比手术便宜，特别是在缺乏VMMC手术所需基础设施和人员的环境中，这可能会导致程序性的成本节约。在莫桑比克，与PrePex相比，外科手术的成本似乎较低，主要是因为消耗品成本较高。随着设备单位成本的降低，PrePex VMMC可以变得更具成本效益，并被认为是对莫桑比克VMMC扩大计划的补充。背景根据世界卫生组织/联合国艾滋病毒/艾滋病联合规划署1于2007年提出的建议，东非和南部非洲的14个国家在其艾滋病毒预防计划中增加了自愿医疗男性包皮环切术(VMMC)。建模表明，假设男性包皮环切术(MC)总数为2030万例，在5年内将VMMC在13个东非和南部非洲国家的覆盖率扩大到80%，并在2025年之前保持这一覆盖率，可以在此期间避免340万艾滋病毒感染，并节省165亿美元的治疗费用。2.达到80%覆盖率目标的进展因国家而异，没有预期的那么快。根据最近的估计，自2007年开始第一个全国性的VMMC方案以来，预计到2015年底，总共将有1000万男性接受割礼。3.
Background:The PrePex device has proven to be safe for voluntary medical male circumcision (VMMC) in adults in several African countries. Costing studies were conducted as part of a PrePex/Surgery comparison study in Zimbabwe and a pilot implementation study in Mozambique.Methods:The studies calculated per male circumcision unit costs using a cost–analysis approach. Both direct costs (consumable and nonconsumable supplies, device, personnel, associated staff training) and selected indirect costs (capital and support personnel costs) were calculated.Results:The cost comparison in Zimbabwe showed a unit cost per VMMC of $45.50 for PrePex and $53.08 for surgery. The unit cost difference was based on higher personnel and consumable supplies costs for the surgical procedure, which used disposable instrument kits. In Mozambique, the costing analysis estimated a higher unit cost for PrePex circumcision ($40.66) than for surgery ($20.85) because of higher consumable costs, particularly the PrePex device and lower consumable supplies costs for the surgical procedure using reusable instruments. Supplies and direct staff costs contributed 87.2% for PrePex and 65.8% for surgical unit costs in Mozambique.Discussion:PrePex device male circumcision could potentially be cheaper than surgery in Zimbabwe, especially in settings that lack the infrastructure and personnel required for surgical VMMC, and this might result in programmatic cost savings. In Mozambique, the surgical procedure seems to be less costly compared with PrePex mainly because of higher consumable supplies costs. With reduced device unit costs, PrePex VMMC could become more cost-efficient and considered as complementary for Mozambique's VMMC scale-up program.BACKGROUNDFollowing the recommendations from World Health Organization/Joint United Nations Programme on HIV/AIDS 1 in 2007, 14 countries in East and Southern African have added voluntary medical male circumcision (VMMC) to their HIV prevention programs. Modeling suggests that scaling up VMMC in 13 Eastern and Southern African countries to 80% coverage over 5 years, assuming a total of 20.3 million male circumcisions (MCs), and maintaining that coverage through 2025 could avert 3.4 million HIV infections over that period and save $16.5 billion in treatment costs. 2 Progress to reach the 80% coverage target has varied by country and has not been as fast as expected. According to recent estimates, it is expected that a total of 10 million men will have been circumcised by the end of 2015 since the first national VMMC programs started in 2007. 3