Table 1. Cost in USD (%) of one MC surgery using PrePex and forceps-guided method under various assumptions.
| Assumptions | Direct Costs | Indirect costs | Subtotal (Direct Costs) | Subtotal (Indirect Costs) | Total | ||||||||
| Consumable supplies | Non-consumable supplies | Direct Personnel | Training | Capital | Maintenanceand utility | Support personnel | Management and supervision | ||||||
| Forcepsguided | 1 | F/U = 60% AE rate = 2.2% | 9.35 (17) | 6.71 (12) | 10.72 (19) | 0.97 (2) | 2.57 (5) | 3.47 (6) | 10.78 (20) | 10.72 (19) | 27.75 (50) | 27.54 (50) | 55.29 |
| 2 | F/U = 41% AE rate = 0.9% | 8.91 (16) | 6.51 (12) | 10.59 (19) | 0.97 (2) | 2.57 (5) | 3.47 (6) | 10.78 (20) | 10.72 (20) | 26.98 (49) | 27.54 (51) | 54.52 | |
| PrePex | 3 | phimosis = 0% 2clinicians AE rate = 0.5% | 5.32 (12) | 5.45 (12) | 8.03 (18) | 0.65 (1) | 2.52 (6) | 3.47 (8) | 9.64 (21) | 10.72 (23) | 19.44 (42) | 26.35 (58) | 45.79 |
| 4 | phimosis = 10% 2clinicians AE rate = 0.5% | 5.34 (11) | 5.48 (11) | 8.06 (16) | 0.72 (1) | 2.82 (6) | 3.87 (8) | 10.77 (22) | 11.97 (24) | 19.60 (40) | 29.43 (60) | 49.02 | |
| 5 | phimosis = 0% 1 clinician, 1 non-clinician AE rate = 0.5% | 5.32 (12) | 5.45 (12) | 6.77 (15) | 0.65 (1) | 2.52 (6) | 3.47 (8) | 9.64 (22) | 10.72 (24) | 18.18 (41) | 26.35 (59) | 44.54 | |
| 6 | phimosis = 10% 1clinician, 1 non-clinicianAE rate = 0.5% | 5.34 (11) | 5.48 (11) | 6.80 (14) | 0.72 (2) | 2.82 (6) | 3.87 (8) | 10.77 (23) | 11.97 (25) | 18.34 (38) | 29.43 (62) | 47.76 | |
AE, Adverse Event; F/U, follow-up; not all percentages add to 100 due to rounding.
Consumable Supplies. Both methods: non-sterile gloves, alcohol hand rub, antiseptic soap, providone antiseptic solution, diclofenac {analgesic} tabs, paraffin gauze {Vaseline gauze}, gauze swabs, cohesive bandage. PMC: Lignocaine cream {local anesthesia cream}. FGMC: sterile gloves, face mask, Bupivacaine, Lignocaine, Needles (21 gauge and 19 gauge), 10 ml syringe, surgical blade (size 10), chromic catgut suture 3/0.
Non-consumable supplies. Both methods: client underpants. FGMC: weighing scale, blood pressure cuff, thermometer, surgical scrubs, shoe cover, sterile drape, center 'o', circumcision surgical tray (gallipot Kocher clamp mosquito artery forceps, blade holder, kidney dish, Dunhill artery forceps, tissue scissors, suture scissors, Adson forceps, needle holder, sponge holding forceps), emergency tray supplies. PMC: dressing tray (kidney dish, gallipot, sponge holding forceps, scissors).
Direct Personnel: Both methods: counselor, hygiene officer. FGMC: Clinical officer, nurse, consultant urologist (for AEs). PMC: Nurse/nurse pair or nurse/nurse aide pair.
Training: Both methods: 3 days of theory. FGMC: 7 days practicum PMC: 3 days practicum; costs include staff time, lunch/refreshments for participants and trainers, stationery, and MC manual.
Capital: Both methods: autoclave (PMC assumed to use 1/2 that of FGMC), surgical couch, cell phones, incinerator, office furniture, vehicles, facility space, generator, surgical equipment (mayo tray, trolley, waste bin).
Maintenance and Utility: Both methods: internet, office rent, electricity (power), water, vehicle costs (maintenance, insurance, and fuel). FGMC: facility renovations.
Support Personnel: Both methods: MOH supervision, quality assurance/quality improvement (QA/QI) team, training team, department managers and staff (human resources, transport, finance, administration, stores, information technology, data, mobilization). PMC: MOH supervision, mobilization team, QA/QI team and training team assumed to require 1/2 the full-time equivalents of FGMC.
Management and Supervision: Both methods: senior management team salaries, travel expenses for circumcision camps and management supervision.