Cutting Out Circumcision Could Cost Billions: Study

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By DR. TIFFANY CHAO, ABC News Medical Unit

Declines in infant male circumcision in the United States could add more than $4.4 billion in avoidable health care costs for sexually transmitted infections, experts warn in a new report.

In a paper in the Archives of Pediatrics & Adolescent Medicine, a team of health economists and disease experts at Johns Hopkins cite the declining rates of U.S. infant male circumcision - from 79 percent in the 1970s to approximately 55 percent today - as responsible for billions of dollars spent in the U.S. on preventable infections.

The decline in circumcision rates has already cost the nation an estimated $2 billion, the researchers say, and if rates decrease to the 10 percent levels seen in Europe, this could mean an additional $4.4 billion for the nation.

The cost of treating sexually transmitted infections in both males and females that could be prevented with circumcision accounts for most of this total. Circumcision removes the foreskin at the end of the penis, which would otherwise potentially serve as a haven for bacteria and viruses that can cause diseases including HIV, herpes, genital warts, bacterial infections and urinary tract infections. Research has also suggested that circumcision can cut risk of penile and prostate cancers in men, as well as cervical cancer risk in their female partners.

There are many possible reasons for the decline in circumcisions. Many families may be averse to circumcision for personal reasons, object to a procedure that was imposed in the past because of religious beliefs. Arleen Leibowitz and Katherine Desmond of UCLA's department of public policy write in a comment following the paper that "low income families' decisions to circumcise their newborn boys are quite responsive to whether or not Medicaid pays for the procedure."

Dr. Aaron Tobian, the principal study investigator, agreed that Medicaid funding cuts are partially to blame. Such cuts have already caused many states to stop paying for infant male circumcisions. California, North Dakota, Oregon, Mississippi, Nevada and Washington stopped funding before 1999, and in the last decade, Missouri, Arizona, North Carolina, Montana, Utah, Floria, Maine, Louisiana, Idaho, and Minnesota all stopped Medicaid funding for circumcision. The most recent states to ban funding were Colorado and South Carolina, in 2011.

"The financial and health consequences of these decisions are becoming worse over time, especially if more states continue on this ill-fated path," said Tobian, who is an assistant professor of pathology at the Johns Hopkins Center for Global Health. "State governments need to start recognizing the medical benefits as well as the cost savings from providing insurance coverage for infant male circumcision."

Other experts agree that this finding should have policy implications.

"States' efforts to reduce current costs by eliminating Medicaid coverage for male circumcision are penny wise and pound foolish," write Leibowitz and Desmond. "Investing today in a relatively low-cost procedure will avert greater future treatment costs for cancer, HIV, and other sexually transmitted infections."