Cost Analysis of Neonatal Circumcision in a Large Health Maintenance Organization

Schoen, Edgar J.
Colby, Christopher J.
To, Trinh T.

Department of Genetics, Kaiser Permanente Medical Center and Division of Research, Kaiser Permanente Medical Care Program, Oakland, California

^*Correspondence: Department of Genetics, Kaiser Permanente Medical Center, 280 W. MacArthur Blvd., Oakland, California 94611-5693 (telephone: 510-752-6585; FAX: 510-752-6754; e-mail: [email protected]).

Presented at annual meeting of Pediatric Academic Societies, Baltimore, Maryland, April 28-May 1, 2001.

Supported by a grant from Kaiser Permanente Medical Care Program, Northern California.

Study protocol received KP Northern California institutional review board approval.

Submitted for publication May 20, 2005.

Journal of Urology 175(3):p 1111-1115, March 2006.

Purpose

We studied the costs of newborn circumcision in relation to its health benefits later in life.

Materials and Methods

We conducted a retrospective database analysis using direct internal cost data from Kaiser Permanente Northern California—a large health maintenance organization—and published cost data (including the cost of medically indicated postneonatal circumcision). The study cohort consisted of 14,893 male infants born in 1996. One-way sensitivity analysis was used to demonstrate the impact of selected variables in the model. Monte Carlo analysis was used to determine the 95% confidence intervals.

Results

Postneonatal circumcision was 10 times as expensive as neonatal circumcision ($1,921 per infant vs $165 per newborn), and was medically indicated for 9.6% of uncircumcised males. Cost benefits of circumcision resulted from prevention of infant urinary tract infection, balanoposthitis, phimosis, HIV infection and penile cancer. Assuming initial neonatal circumcision cost to be $200, the future health care cost offset (avoided) was calculated as $183 (range $93 to $303 in 95% of simulations).

Conclusions

Multiple lifetime medical benefits of neonatal circumcision can be achieved at little or no cost. Because postneonatal circumcision is so expensive, its rate is the most important factor determining future cost savings from newborn circumcision.