Much of the debate over routine infant circumcision has centered on the ethics of the procedure, in which a male's foreskin is removed.
But a new study published Monday by health economists with the Johns Hopkins University School of Medicine shifts the focus toward money. It says that if circumcision rates were to decline to the 10 percent level currently seen in Western Europe, it could add up to $505 million annually in direct health care costs.
"This is the first study ever conducted in the U.S. that has looked at the economic costs [of circumcision]," study author Dr. Aaron Tobian, a health epidemiologist and pathologist with Johns Hopkins, told The Huffington Post. "We believe that state Medicaid and private insurers should assess these data and recognize not only the medical benefits [of circumcision], but also the financial impact of denying coverage."
Rates of male circumcision have dropped significantly in the past several decades, from 79 percent of baby boys born in the 1970s and 80s to approximately 55 percent by 2010, the study said. They estimate that for every year the male circumcision rates are at that level, the U.S. health care system can expect to pay $211 million more than it would have had rates remained at that 79 percent peak. Over a 10-year period, that would equal about $2 billion in avoidable health care costs.
And if rates were to fall to 10 percent, or what they currently are in Europe where insurance coverage for routine circumcision is rare, lifetime health care costs would increase by approximately $400 per male and $40 per female, the researchers said. Over the next decade, that would equal approximately $4.4 billion.
"These are conservative estimates," Tobian said. "We only assessed direct medical cost. It does not include indirect [costs], such as patient or caregiver productivity lost."
Most of the money would be spent on treating sexually transmitted infections, the authors said.
But opponents to male circumcision, sometimes called "intactivists," argue that the health benefits of routine male circumcision are unproven. Georganne Chapin, founding executive director of the advocacy group Intact America, called some of the figures in the new study "trash."
"They have no evidence -- because there isn't any -- to back up these figures," Chapin said in a statement. "Commonwealth and European countries where male circumcision is rare have equal-to or better health status than the U.S."
Over the last several years, randomized trials in Africa have tied male circumcision to decreased risk of HIV infection as well as human papillomavirus (HPV), which can increase risk of cervical and other types of cancer. A 2010 trial, on which Tobian was an author, concluded that circumcision lowered the risk of genital herpes.
In the new study, published online in the Archives of Pediatric Medicine, Tobian and his colleagues estimated that if circumcision rates in the U.S. fell to 10 percent, the lifetime prevalence of HIV among men would increase by 12 percent, HPV by 29 percent, herpes type 2 by 20 percent and urinary tract infections by 212 percent. Women would also experience increases in sexually transmitted infections, such as bacterial vaginosis, a type of vaginal inflammation, and trichomoniasis, which is caused by a parasite.
"Documentation that male circumcision not only reduces the burden of STIs [sexually transmitted infections] for both men and women but also reduces lifetime treatment costs should provide compelling arguments in favor of infant male circumcision," wrote Arleen Leibowitz, an economist and professor of public policy and Katherine Desmond, a statistician, both with the University of California Los Angeles in an editorial accompanying the findings.
Medicaid programs in 18 states in the U.S. currently do not provide coverage for routine circumcision of baby boys, and local governments in California attempted to pass bans on the practice, but those attempts were blocked by Gov. Jerry Brown last fall.
Parents and health experts now have their eyes trained on the American Academy of Pediatrics, which will release its new circumcision policy statement at the end of August. Since 1999, that group has said that there is existing scientific evidence that demonstrates the "potential" medical benefits of newborn male circumcision, but not enough to recommend it routinely.
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