Declining circumcision rates may add $4 billion in U.S. health care costs, researchers say

Nurse Angie Hagen tends to a new born baby boy in the nursery at Denver Health medical facility in Denver on Thursday, June 23, 2011. Colorado will end coverage for routine circumcisions under Medicaid next month, adding to what's become a national debate over the once widely-accepted procedure. The change will take effect July 1. Lawmakers agreed to end funding as part of a package of cuts to balance the budget. AP Photo/Ed Andrieski

circumcision
Nurse Angie Hagen tends to a new born baby boy in the nursery at Denver Health medical facility in Denver on Thursday, June 23, 2011.
AP Photo/Ed Andrieski

(CBS News) Circumcision rates in the United States have been falling among newborn males. Recent CDC figures show the circumcision rate fell from nearly 63 percent of newborn boys in the U.S. in 1999 to about 55 percent in 2010. But, back in the 1970s through the 1980s, circumcision rates were stable at about 79 percent of baby boys.

The procedure has been tied to health benefits, including reduced risk for infections or sexually transmitted diseases like HIV. Now, a group of researchers from Johns Hopkins University say the declining male circumcision (MC) rates may be contributing to an uptick in medical problems, adding billions of dollars in additional U.S. health care costs.

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"Our economic evidence is backing up what our medical evidence has already shown to be perfectly clear," study author Dr. Aaron Tobian, an assistant professor of epidemiology and pathology at the Johns Hopkins University School of Medicine, said in a written statement. "There are health benefits to infant male circumcision in guarding against illness and disease, and declining male circumcision rates come at a severe price, not just in human suffering, but in billions of health care dollars as well."

For the study, Tobian and his team used computer simulations to estimate how much added health care costs would stem from U.S. circumcision rates dropping to only 10 percent of U.S. newborn males - about 4 million males, which is similar to the European. They found over a lifetime, such circumcision rates would tack on an extra $407 in costs per man and $43 per woman.

Specifically, the researchers calculated that if circumcision rates were to dip to 10 percent, there would be a 212 percent increase in cases of male urinary tract infections and a 12 percent increase in HIV infections in men, along with a 29 percent rise in HPV infections and a 20-percent rise in herpes infections.

Women would also be at greater risk, the researchers said, with a reported 51 percent increases in the infection bacterial vaginosis, an 18-percent rise in high-risk HPV infections and a 12.9 percent rise in low-risk HPV.

In total, that's $4.4 billion in avoidable health care costs, say the researchers. As is, the 20-year decline in rates have already contributed to upwards of $2 billion in added costs. They also note that 18 states have already abolished Medicaid coverage for male circumcisions, considering it an optional procedure.

"Although there are multiple factors that contribute to a nation's MC rate, it is likely that reductions in insurance coverage play a role in lowered MC rates," the authors wrote. "Thus, the financial and health implications of policies that affect MC are substantial."

The findings were published in the August 20 issue of the Archives of Pediatrics and Adolescent Medicine.

In an accompanying editorial published in the same journal, Dr. Arleen A. Leibowitz and Katherine Desmond, health policy researchers at the University of California, Los Angeles, write based on the evidence, "It is now time for the federal Medicaid program to consider reclassifying MC from an 'optional' service to one that all state Medicaid plans will cover for those parents who choose the procedure for their newborn sons."

Tobian said in a statement that part of the problem is that the American Academy of Pediatrics has failed to recognize the medical evidence supporting circumcisions in determining its guidelines.

The academy currently says that circumcision may prevent bladder infections and sexually transmitted diseases like HIV/AIDS, but the organization also notes potential downsides like reduced sensation, infection and thus stops short of recommending the procedure.

The Washington Post however reports that the AAP will update that statement on Monday and will likely conclude that the health benefits of circumcision outweigh the risks.

There has been growing sentiment against male circumcision has been increasing in recent years as advocates argue the procedure is form of genital mutilation in defenseless babies. Last summer, a group of San Francisco voters had petitioned to get a male circumcision ban on the November city ballot, only for a judge to say such a decision should be decided by the state.

This summer in Germany, a local court in Cologne had ruled circumcision went against the "fundamental right of the child to bodily integrity outweighed the fundamental rights of the parents" in banning circumcisions until a child could decide for himself. Religious leaders have opposed the ruling.

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