The Cost of Medicaid Savings: The Potential Detrimental Public Health Impact of Neonatal Circumcision Defunding

Table 5

Projected additional female cases of HIV and additional direct medical costs^a.

	African; American; 𝑛=6379	White; 𝑛=5620	Other; 𝑛=2462	Total; 𝑛=14,461
Baseline prevention fraction (46%)^b
Additional HIV cases	35	5	7	47
Additional cost discounted to time of infection^c	$13,113,500	$1,839,700	$2,758,200	$17,711,400
Additional cost discounted to birth^d	$5,316,900	$777,200	$1,197,900	$7,292,000
Highest prevention fraction (69%)^b
Additional HIV cases	90	10	12	112
Additional cost discounted to time of infection^c	$34,095,100	$3,942,200	$4,597,000	$42,634,300
Additional cost discounted to birth^d	$13,824,000	$1,665,400	$1,996,500	$17,485,900
Lowest prevention fraction (4%)^b
Additional HIV cases	2	.3	.5	2.8
Additional cost discounted to time of infection^c	$786,800	$105,100	$183,900	$1,075,800
Additional cost discounted to birth^d	$319,000	$44,400	$79,900	$443,300

^aPer South Carolina Medicaid birth year cohort.
^bPrevention fraction (1-relative risk) of male circumcision for reducing HIV transmission through heterosexual contact.
^cUsing Schackman et al.’s discounted lifetime HIV treatment cost (discounted to time of infection) of $303,100 (in $US2004) inflated to $US2010 for a lifetime treatment cost of $377,360.
^dTo allow for direct comparison to circumcision savings in the cohort birth year.