Purpose: Based on the reduction in HIV incidence among circumcised v. uncircumcised heterosexual African men found by three clinical trials, we assessed the effect of neonatal circumcision on US males' expected lifetime cost of HIV.

Methods: We used vital statistics data on general and HIV-specific mortality, census data, and HIV surveillance data jointly to calculate cross-sectional, period (2003-2004) and age-specific probabilities of an HIV diagnosis. These estimates were then combined using the double-decrement life-table method to estimate the lifetime risk, from birth, of being diagnosed with HIV for all males and by race/ethnicity. We calculated the fraction of lifetime risk attributable to heterosexual behavior based on HIV surveillance data on transmission for men diagnosed in 2003-2004. We assumed lifetime HIV risk from heterosexual behavior only reflected a 50% reduced risk among circumcised males. Race-ethnicity-specific circumcision rates were obtained from the National Health and Nutrition Examination Survey, 1999-2004. We calculated the difference in lifetime HIV risk among circumcised v. uncircumcised males, and multiplied the risk by lifetime treatment costs to obtain expected lifetime treatment costs. Lifetime treatment costs, discounted to time of birth and assuming an average age of infection of 36, were $113,381. In a sensitivity analysis, we examined the effect of different assumptions about circumcision prevalence, efficacy in preventing HIV among men who have sex with men and duration of efficacy, and age of infection. Based on the National Inpatient Survey, we estimated a cost of $678 for newborn circumcision.

Results: The difference in expected lifetime cost was most sensitive to assumptions about the efficacy of circumcision in preventing HIV over a lifetime and least sensitive to estimates of age at HIV infection.

Conclusions: Neonatal circumcision reduced the expected lifetime cost of HIV among all males by 14.3%. The absolute cost difference ranged from $102 among white males to $1,134 among black males. Expected savings in HIV lifetime treatment costs partially or entirely offset the cost of newborn circumcision.