Cost comparison of the ShangRing device versus Mogen clamp for early infant male circumcision in Sub-Saharan Africa
9 affiliations
- 1Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, United States of America
- 2Department of Urology, Mayo Clinic Arizona, Phoenix, Arizona, United States of America
- 3Department of Urology, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- 4Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- 5The Population Council, New York, New York, United States of America
- 6Jhpiego, Dar es Salaam, Tanzania
- 7Rakai Health Sciences Program, Entebbe, Uganda
- 8Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States of America
- 9Avenir Health, Glastonbury, Connecticut, United States of America
Abstract
Introduction: The World Health Organization (WHO) endorses male circumcision as an effective human immunodeficiency virus (HIV) prevention intervention in settings where the expected impact is greatest, including Sub-Saharan Africa. Data on cost implications of early infant male circumcision (EIMC) are limited. The ShangRing (SR) is a WHO pre-qualified device for circumcision. We sought to perform a comprehensive cost assessment alongside a randomized controlled trial (RCT) of the SR versus the standard of care Mogen clamp (MoC) for EIMC to enable future scale-up towards a cost-effective HIV prevention strategy. Methods: We collected resource utilization and economic data as part of an RCT of infants aged 0–60 days old undergoing EIMC in Kenya, Tanzania, and Uganda. Cost data for both the SR and MoC included baseline facility costs, direct costs, and indirect costs. The Decision Makers Program Planning Tool v1.0 was used to perform a direct cost comparison of these two devices. The Goals model was used to compare the costs of EIMC in 2023 using the present value of money to circumcise an adolescent male 15 years from now. Results: A total of 1,378 infant males underwent circumcision, 689 via SR and 689 via MoC. The overall cost of a single EIMC in Kenya, Tanzania, and Uganda were 61.30 United States Dollars ($), $47.14, and $64.59 respectively for the SR, and $56.38, $50.43, and $58.57 respectively for the MoC. In Kenya, EIMC would be less expensive based on nominal present costs in 2023 compared to waiting for adolescent circumcision at age 15 years in 2038. This finding is reversed in Tanzania and Uganda. Conclusions: The overall cost of EIMC via SR versus MoC is comparable in an RCT. With scale-up utilizing lower level personnel, the cost of SR may be further reduced. The SR is an attractive alternative for future EIMC initiatives in Sub-Saharan Africa to further reduce HIV burden.
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BibTeX
@article{punjani2026cost,
title = {{Cost comparison of the ShangRing device versus Mogen clamp for early infant male circumcision in Sub-Saharan Africa}},
author = {Nahid Punjani and Tenny R. Zhang and Spyridon P. Basourakos and Mark A. Barone and Alice Christensen and Godfrey Kigozi and Marc Goldstein and Philip S. Li and Alvin I. Mushlin and John Stover and Richard K. Lee},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0360356},
url = {https://doi.org/10.1371/journal.pone.0360356},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Cost comparison of the ShangRing device versus Mogen clamp for early infant male circumcision in Sub-Saharan Africa
AU - Nahid Punjani
AU - Tenny R. Zhang
AU - Spyridon P. Basourakos
AU - Mark A. Barone
AU - Alice Christensen
AU - Godfrey Kigozi
AU - Marc Goldstein
AU - Philip S. Li
AU - Alvin I. Mushlin
AU - John Stover
AU - Richard K. Lee
PY - 2026
DA - 2026/10/13
JO - PLOS One
DO - 10.1371/journal.pone.0360356
UR - https://doi.org/10.1371/journal.pone.0360356
AB - Introduction: The World Health Organization (WHO) endorses male circumcision as an effective human immunodeficiency virus (HIV) prevention intervention in settings where the expected impact is greatest, including Sub-Saharan Africa. Data on cost implications of early infant male circumcision (EIMC) are limited. The ShangRing (SR) is a WHO pre-qualified device for circumcision. We sought to perform a comprehensive cost assessment alongside a randomized controlled trial (RCT) of the SR versus the standard of care Mogen clamp (MoC) for EIMC to enable future scale-up towards a cost-effective HIV prevention strategy. Methods: We collected resource utilization and economic data as part of an RCT of infants aged 0–60 days old undergoing EIMC in Kenya, Tanzania, and Uganda. Cost data for both the SR and MoC included baseline facility costs, direct costs, and indirect costs. The Decision Makers Program Planning Tool v1.0 was used to perform a direct cost comparison of these two devices. The Goals model was used to compare the costs of EIMC in 2023 using the present value of money to circumcise an adolescent male 15 years from now. Results: A total of 1,378 infant males underwent circumcision, 689 via SR and 689 via MoC. The overall cost of a single EIMC in Kenya, Tanzania, and Uganda were 61.30 United States Dollars ($), $47.14, and $64.59 respectively for the SR, and $56.38, $50.43, and $58.57 respectively for the MoC. In Kenya, EIMC would be less expensive based on nominal present costs in 2023 compared to waiting for adolescent circumcision at age 15 years in 2038. This finding is reversed in Tanzania and Uganda. Conclusions: The overall cost of EIMC via SR versus MoC is comparable in an RCT. With scale-up utilizing lower level personnel, the cost of SR may be further reduced. The SR is an attractive alternative for future EIMC initiatives in Sub-Saharan Africa to further reduce HIV burden.
SN - 1932-6203
ER -