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Estimating the cost efficiency of the PrePex circumcision device in Zambia

AIDS 2014, Melbourne, Australia July 25 th , 2014. Estimating the cost efficiency of the PrePex circumcision device in Zambia. Authors: L . Vandament , B. Tambatamba, A. Kaonga, P. Clark, A. Samona , F. Mpasela, N. Chintu. GOVERNMENT OF THE REPUBLIC OF ZAMBIA.

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Estimating the cost efficiency of the PrePex circumcision device in Zambia

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  1. AIDS 2014, Melbourne, Australia July 25th, 2014 Estimating the cost efficiency of the PrePex circumcision device in Zambia Authors: L. Vandament, B. Tambatamba, A. Kaonga, P. Clark, A. Samona, F. Mpasela, N. Chintu GOVERNMENT OF THE REPUBLIC OF ZAMBIA

  2. Devices present a potential solution to the human resource constraints faced by countries scaling up male circumcision • Beginning in 2007, fourteen African countries set ambitious short-term targets to reach universal coverage of MC among the existing population of sexually active men. • However, increasing access to a surgical procedure in resource limited countries facing human resource shortages has proven to be a challenge. • Despite significant donor support, and the proliferation of service delivery models for resource limited setting, as of December 2012 priority countries had achieved only 15.2%1 of their 2015 targets. • MC devices, such as PrePex, may allow for increased provider productivity and task shifting, lessening HR constraints. 1. WHO, Progress in scaling up VMMC for HIV prevention in East and Southern Africa, 2013.

  3. A comparative cost analysis for surgical vs. PrePex circumcision was conducted in Zambia to inform potential introduction • PrePexis non-surgical, reducing procedure times and potentially reducing HR costs per MC by increasing output. • The device is currently approved for adults 18+ (~60% of demand in Zambia) and studies suggest that an additional 7.4%3of adults are ineligible for anatomical reasons. • At the time of the study, the device cost was $20. 2. WHO, Guideline on the use of Devices for Adult Male Circumcision for HIV Prevention, October 2013

  4. Data on staffing, commodity consumption and output was analyzed to calculate unit cost during the study period • Comparison: Standalone PrePex service delivery compared to standalone surgical circumcision services (dorsal slit method) • Data collected: • Volume of commodities (procurement and consumption data) • Number of health care workers providing services • Number of staff conducting demand creation activities • Number of daily MCs performed • Study sites: 2 urban Society for Family Health sites in Lusaka • Timeframe: Oct 7 - Dec 31, 2013 • Analysis: Estimated unit cost of service delivery by method

  5. Unit cost comparison of PrePex and surgical circumcision Average unit cost of MC by method $109.96 $81.66

  6. Human resource cost per MC by method $78.04 $68.17 • In Zambia, both the provider and the assistant for all circumcisions must be trained providers, leading to a relatively high unit cost for provider time.

  7. Distribution of MC method by age group PrePex is currently pre-qualified for 18+

  8. Projected PrePexunit cost for varying levels of adult uptake Cost parity would have been achieved at 81% uptake during the study for a $20 device

  9. Expected impact of PrePex introduction on the cost of scale up A projection of the annual cost of scale-up in Zambia for 2 scenarios USD, millions • Increased commodity costs for PrePex circumcisions offset human resource cost savings, leading to very similar scale up costs under both scenarios

  10. Further research is required to identify models which would allow PrePex to generate costs savings in Zambia • In our initial study, cost parity for current levels of demand was only achievable above 80% uptake for adults 18+. • In our revised analysis looking at the cost of “mixed” service delivery, even high levels of PrePex uptake failed to yield material cost savings. • Alternate scenarios using a reduced PrePex price of $12 or where the age of eligibility was reduced to 13 years did not change results substantially. • Further studies which evaluate the economics of PrePex only sites, as well as demand creation models targeted to PrePex are needed.

  11. Acknowledgements • The MC unit at the Ministry of Community Development, Mother & Child Health • The data collection team from CHAI Zambia - Felton Mpasela & Trevor Mwamba • The Society for Family Health staff at YWCA and Chachacha health centres • The study staff from ZPCTII (FHI360) • The Bill & Melinda Gates Foundation • AIDS 2014! GOVERNMENT OF THE REPUBLIC OF ZAMBIA

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