Circumcision can cut health care costs RESEARCH

Los Angeles -- Declining rates of circumcision among infants will translate into billions of dollars' worth of unnecessary medical costs in the United States as the boys grow up and become sexually active men, researchers at Johns Hopkins University said.

In a study published Monday in the Archives of Pediatric and Adolescent Medicine, a team of economists and epidemiologists estimated that every circumcision not performed would lead to significant increases in lifetime medical expenses to treat sexually transmitted diseases and related cancers - increases that far surpass the costs associated with the procedure.

Circumcision is a hotly debated and emotional issue in the United States, where rates have been falling for decades. In the 1970s and 1980s, about 80 percent of baby boys were routinely circumcised in hospitals or during religious ceremonies; by 2010, that figure had dropped below 55 percent, according to the Centers for Disease Control and Prevention.

Some of that decline is due to shifting attitudes among parents, but at least part of it can be traced to the decision by many states to eliminate Medicaid coverage for the procedure. Today 18 states, including California, do not provide Medicaid coverage for the procedure, which is considered cosmetic by many physicians.

But in the past decade, studies have increasingly shown that removing the foreskin of the penis has significant health benefits, said Dr. Aaron Tobian, senior author of the new study.

Circumcision is believed to prevent STDs by depriving pathogens of a moist environment where they can thrive. The inner foreskin has been shown to be highly susceptible to HIV in particular because it contains large numbers of Langerhans cells, a target for the virus.

Tobian and his colleagues developed a computer simulation to estimate whether declining circumcision rates would lead to more STDs and thus higher medical costs.

If circumcision rates remain around 50 percent instead of the higher rates of years past, the lifetime health care costs for all of the babies born in a single year will probably rise by $211 million, the team calculated.

If circumcision rates were to fall to 10 percent - which is typical in countries where insurance does not cover the procedure - lifetime health care costs for all the babies born in a year would go up by $505 million. That works out to $313 in added costs for every circumcision that doesn't happen, according to the report.

In this scenario, nearly 80 percent of the additional projected costs were due to medical care associated with HIV infection in men, the team wrote.