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

Table 2

Example calculation of black male expected heterosexually acquired HIV cases and cost; SC 2009 Medicaid birth cohort.

Cohort age	Expected cases by year at current circumcision rates; (population^a  × age/gender/race specific incidence rate)	Expected heterosexually acquired cases by year; (cases per year ×  % heterosexually acquired)^b	Total acquired cases by year if no circumcision; (heterosexually acquired cases by year × calculated factor)^c	Additional acquired cases expected if no circumcision; (total cases-expected cases)	Lifetime HIV treatment cost for additional cases acquired per year (discounted to time of infection)^d
13	6399×.00018=1.15	1.15×.227=.26	.26×1.8=.47	.47−.26=.21	.21×$377,360=$78,978
14	6399×.00018=1.15	1.15×.227=.26	.26×1.8=.47	.47−.26=.21	.21×$377,360=$78,978
15	6399×.00018=1.15	1.15×.227=.26	.26×1.8=.47	.47−.26=.21	.21×$377,360=$78,978

^a2009 SC medicaid birth cohort—black male population.
^bCDC HIV surveillance report statistics on diagnosis of HIV infection by race/ethnicity, gender, and transmission category (22.7% of black male HIV infections were reported as heterosexually transmitted).
^cSee Table 3 for explanation of factor calculation.
^dUsing Schackman et al’s discounted lifetime HIV treatment cost of $303,100 (in $US2004) inflated to $US2010 for a lifetime treatment cost of $377,360 per case.