Evaluating the cost of adult voluntary medical male circumcision in a mixed (surgical and PrePex) site compared to a hypothetical PrePex-only site in South Africa

Figures & data

Table 1 Unit cost for forceps-guided male circumcision and PrePex male circumcision in a mixed site and a hypothetical PrePex-only site in South Africa

	Mixed site				Hypothetical PrePex-only site
Cost category	Surgery		PrePex		PrePex
Direct costs
Consumables	$18.77	32%	$24.33	41%	$24.33	48%
Non-consumable supplies	$0.04	0%	$0.04	0%	$0.04	0%
Waste management	$4.01	7%	$1.11	2%	$1.11	2%
Personnel	$8.00	13%	$5.27	9%	$5.27	10%
Training	$1.05	2%	$1.05	2%	$0.83	2%
Subtotal	$31.86	54%	$31.80	53%	$31.58	62%
Indirect costs
Capital	$1.58	3%	$1.58	3%	$1.97	4%
Maintenance and utility	$8.23	14%	$8.23	14%	$6.58	13%
Support personnel	$13.81	23%	$13.81	23%	$7.73	15%
Management and supervision	$3.93	7%	$3.93	7%	$3.15	6%
Subtotal	$27.56	46%	$27.56	47%	$19.42	38%
Total unit cost	$59.42		$58.82		$51.00
Total unit cost weighted with complications	$59.62		$59.53		$51.10
Average unit cost weighted with complications	$59.61				$51.21

Fig. 1 One-Way Sensitivity Analysis. Shown are all parameters that, when varied across the ranges shown, changed the estimated difference in cost of circumcision (mixed site minus PrePex-only site).

Table 2 The range of key parameters in the cost model

	Mixed site		Hypothetical PrePex-only site
	Baseline	Range (2.5th–97.5th percentiles)	Baseline	Range (2.5th–97.5th percentiles)
Personnel
Time per FGMC (min)
1 Enrolled nurse	31.1±5.4	21, 37	N/A
1 Medical officer or 1 clinical associate	5.3±1.0	4, 7
Time for PrePex circumcision (min)
1 Enrolled nurse and 1 professional nurse	7.9±4.3	2, 21	7.9	2, 21
	Baseline	(−50%, +50%)	Baseline	(−50%, +50%)
Support personnel
Number of full-time support personnel	14	7, 21	4	2, 6
Number of management staff	2	1, 3	1	0, 2
Capital
Facilities size (m^2)	N/A		112	56, 168
Patient volume (capacity)
Annual utilization of capacity(%)	49.5	24.8, 74.3	49.5	24.8, 74.3

Fig. 2 Total expected cost for 10,000 male circumcision at the mixed site and a PrePex Only site. Costs were modeled for different costs of PrePex kit at A) PrePex at $20 B) PrePex at $10, and C) PrePex at $2.