Dear Editor,

We have read the important work published by Obiero Et Al titled: "The PrePex Device Is Unlikely to Achieve Cost-Savings Compared to the Forceps-Guided Method in Male Circumcision Programs in Sub-Saharan Africa".

We believe the ideal way to calculate cost effectiveness is to use actual costs when using a specific method. Our national research center in Rwanda has studied the PrePex device over the course of several major World Health Organization guided and audited studies, whereby we also submitted the evidence to the Bill & Melinda Gates Foundation, PEPFAR and UNAIDS. One study showed the direct and indirect costs of using the device for adult male circumcision (MC). We have also compared PrePex MC costs to Surgical MC costs based on absolute costs and not on planning models. This above referenced article was published based on planning models, not actual usage of the device.

We have found and are about to publish our results which show that the PrePex MC cost is lower than Surgical MC cost with regards to direct and to indirect costs separately. With regards to cost effectiveness we have found the PrePex MC to be more cost effective than the surgical MC cost (it is five times faster, is easier to train low cadre nurses and requires less tools and materials).

We believe our work represents the expected typical cost that a sub-Saharan government will find when considering scale up of MC.

Sincerely,
Vincent Mutabazi M.D.
Director of the Research Grants Unit
Medical Research Centre
Rwanda Biomedical Centre