Comparing Direct Costs of Facility-Based Shang Ring Provision Versus a Standard Surgical Technique for Voluntary Medical Male Circumcision in Zambia

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Abstract

Background:

Rapid scale-up of voluntary medical male circumcision (VMMC) is needed to realize potential reductions in HIV incidence in sub-Saharan Africa. New disposable VMMC devices such as the Shang Ring may offer several advantages over standard surgery, including lower costs.

Methods:

We compared direct costs of the Shang Ring and dorsal slit techniques for delivery of VMMC in the context of a randomized-controlled trial carried out in Zambia in 2011. Information on direct costs of clinician time, disposable supplies, and reusable medical instruments were collected by study staff.

Results:

During the trial, the direct cost of 1 VMMC procedure using the Shang Ring device was US $18.21, whereas the direct cost of using dorsal slit was US $17.67. Higher costs of clinician time related to dorsal slit VMMC were offset by higher costs of disposable supplies with the Shang Ring approach.

Discussion:

Although direct costs were roughly equivalent during this small-scale trial, with the increased demand from scaling up VMMC, a Shang Ring team could provide services at a substantially lower average total cost due to the potential for more intensive use of staff and other fixed resources.

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