Study: Fewer Circumcisions Could Cost the U.S. Billions
As debate rages over the ethics of infant circumcision, a study published Monday said falling rates of the once-routine procedure in the United States could cost billions of dollars in health costs.
"We find that each circumcision not performed will lead to $313 of increased expenditures over that lifetime," said senior investigator Aaron Tobian, of the Johns Hopkins University team that did the study.
The number pits health care costs if the boy is circumcised -- about $291 for the procedure -- against the projected cost of treating infections or cancers that studies have shown are more likely if he is not.
In all, the nearly 25 percent drop in circumcisions since the 1980s could run up a tab of about $2 billion in health care costs, the study found.
And if U.S. circumcision rates were to drop as low as one in 10, the average across Europe, the research team estimated the associated rise in medical expenses would total $4.4 billion over the lifetimes of a decade of babies.
Throughout the 1970s and 1980s, about 79 percent of all baby boys were circumcised in the United States, according to the Center for Disease Control and Prevention (CDC).
But in 2010, that number dropped to just below 55 percent.
The decrease comes amid an outcry from so-called "intactivists" who argue that circumcision is an unnecessary mutilation of baby boys who have no ability to consent.
And circumcisions may become even more rare as a number of states stop covering the procedure in their Medicaid programs -- the public health insurance programs for low income Americans.
Most recently, Colorado and South Carolina joined 16 other states that decline to fund infant circumcision.
In a memo announcing the change in December 2010, South Carolina said it was part of a package to save money, adding that "medically-necessary circumcisions" will still be covered with prior approval.
In California, where the Medicaid program has declined to pay for circumcisions for more than a decade, activists recently tried to get a measure on November's election ballot that would ban circumcision entirely -- a move blocked by the state's governor, with a law outlawing the ban.
-- Keep circumcision routine --
But Tobian said that science indicates all circumcisions are medically "very beneficial and valuable."
"If there were a vaccine to prevent HIV acquisition, genital herpes, HPV, penile and cervical cancer, bacterial vaginosis and trichomoniasis, the medical community would rally behind this intervention as a game-changing tool to reduce sexually transmitted infections."
And that is just what circumcision, a procedure to remove the foreskin, does, according to three randomized trials, "the gold standard of medical evidence," he maintained.
Critics argue circumcision is medically invasive and less effective than safe sex practices, such as using condoms, at reducing sexually transmitted infections.
Tobian agreed that condoms are highly effective, but contended they are not used enough.
"In the United States, we've had three decades of safe sex education, but just last year, there were 19 million new sexually transmitted infections that cost our health care system $17 billion."
He could not say whether Europe, with its long-standing lower rates of male circumcision, has a correspondingly higher rate of the sexually-transmitted infections and their associated medical costs.
It is too difficult a comparison because "we have very different racial and socioeconomic backgrounds and different transmission dynamics," he said.
He also took issue with opponents who argue the procedure is a form of genital mutilation.
He cited a study in Kenya that asked men who were circumcised as adults to compare their sexual satisfaction before and after the procedure. More than half said they noticed "increased penile sensation and enhanced ease of reaching an orgasm with a circumcision."
Tobian and his team urge all state Medicaid programs and private insurers to cover male circumcision. They also suggest that the American Academy of Pediatrics should include a recommendation that all infant boys be circumcised.
The World Health Organization has recommended male circumcision as an "efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence," according to its website.
The study was published Monday in the "Archives of Pediatrics & Adolescent Medicine."