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Background: Researchers in South Africa participated in a demonstration study assessing the feasibility and acceptability of introducing the PrePexTM device for non-surgical voluntary medical male circumcision (VMMC). Devices, such as PrePexTM, are intended to make the circumcision procedure quicker, simpler, and more cost-effective. This study aimed to derive the incremental costs of introducing PrePexTM into facilities where a surgical circumcision programme was already established and fully functioning.
Methods: Cost data were systematically collected through facility surveys and information provided by CHAPS. The contributions of the following cost categories to the unit costs were assessed: direct clinical labour, support staff, medicine and consumables, continuous quality improvement (CQI), overhead, training, equipment and vehicles. Per unit costs were calculated using a costing model employing a top-down approach. All costs were converted into US dollars at the 2014 exchange rate (R 10.83 = US $1).
Results: The overall unit cost was US$121.92 (R1320.41) prior to the introduction PrePexTM and US$117.46 (R1272.04) after the introduction of PrePexTM. The cost per circumcision performed was lower after the introduction of the PrePexTM device because the total number of clients increased considerably, while the total expenditure incurred remained fairly constant.
The only increase in total expenditure was seen among medicines and consumables - total expenditure on medicines and consumables increased from US$ 238,565 (approximately R2.5 million) to US$ 255,491 (approximately R2.7 million), thereby resulting in a 7.1 percent increase in expenditure on medicines and consumables after the introduction of PrePexTM. All other expenditures on equipment, overhead, CQI, and vehicles remained the same.
Conclusions: The introduction of PrePexTM into an existing surgical program did not increase the cost per VMMC. Results indicate that the introduction of PrePexTM in clinical settings where surgical VMMC is already taking place may not result in increased costs per unit since no additional equipment is required for the PrePexTM procedure and the additional costs of medicines and consumables is not expected to be significant. While additional clinical labour might be needed as the total number of VMMC procedures increase, since non-physicians can perform circumcisions using PrePexTM, it is possible that these additional costs may also not be significant.