NEW YORK Aug 20 (Reuters Health) - If gaps in insurance coverage dramatically reduce the number of male babies being circumcised in the United States, related health costs could soar by several billion dollars, a new study suggests. 
 
 In as many as 18 U.S. states, the Medicaid health program for the poor has reduced funding for the procedure, which means fewer parents are opting to have their sons circumcised, according to Dr. Aaron Tobian and his colleagues from Johns Hopkins University in Baltimore. 
 
 His team calculated the future implications for U.S. health costs if that trend continues, and the results were published on Monday in the Archives of Pediatrics & Adolescent Medicine. bit.ly/KEGTVv 
 
 More than half of U.S. baby boys are circumcised today, but Tobian's team says that number could drop to as few as one in ten, in line with rates of circumcision in Europe, where the procedure is rarely covered by insurance. 
 
 Using a model based on studies of the long-term health effects of circumcision, they predicted that such a decline wo uld lead to more than double the rate of urinary tract infections in male babies and a 12 percent increase in the rate of HIV infections in men. 
 
 "The state governments think we can save a few bucks, but it ends up costing them more in the long run," Tobian told Reuters Health. "The medical benefits of male circumcision are extremely clear," he added, referring to reduced rates of HIV, penile cancer and herpes. 
 
 Each circumcision costs Medicaid or private insurers about $250 to $300, Tobian said. His team estimated that each "forgone" circumcision would add a net $313 in costs for extra doctor's appointments, medication and other treatment for men who would contract human immunodeficiency virus (HIV) or human papillomavirus (HPV) as a result of being uncircumcised. 
 
 With a drop from the current circumcision rate of about 55 percent of baby boys to 10 percent, there would be almost 5,000 extra HIV cases in men, 57,000 extra HPV infections and another 27,000 newborn UTIs among about four million babies, they calculated. Related costs would add up to more than $4.4 billion for babies born over a decade-long span, they said. 
 
 PREVENTING THE SPREAD OF DISEASE 
 
 Most of the data for the new model on health consequences came from research done in Africa. But it's reasonable to assume those findings would apply to U.S. men, according to Helen Weiss, an epidemiologist who has studied circumcision at the London School of Hygiene & Tropical Medicine. 
 
 The foreskin is rich in HIV target cells, she told Reuters Health. Therefore a man without foreskin is less likely to contract HIV and some other sexually transmitted infections. 
 
 It's not clear whether circumcised men are also less likely to pass on the diseases to a partner if they are infected, said Weiss, who wasn't involved in the new study. 
 
 "But obviously at the population level, women are less likely to acquire it if there's less HIV in the male population," she added. 
 
 Less transmission of HPV also means women are at lower risk of cervical cancer, which is closely tied to the virus. 
 
 Weiss agreed that male newborn circumcision is "a very cost-effective intervention." It typically hasn't been popular in the UK and the rest of Europe outside of Muslim and Jewish families who circumcise their sons for religious reasons, she added. 
 
 She said evidence from the past five years especially supports the long-term health benefits of circumcision - which itself comes with a very low risk of infection in newborns. 
 
 "We seem to be finding more and more things that circumcision protects against," Weiss said. "If anything, you would expect (insurance) coverage of circumcision to be also increasing." 
 
 The American Academy of Pediatrics' most recent statement on the issue, reaffirmed in 2005, said there is not enough evidence to recommend routine male newborn circumcision. A new draft of that statement is set to be published next week. 
 
 There are also ethical questions about whether it's okay to perform circumcision on a newborn boy who is obviously too young to consent, researchers noted. But as boys get older, the procedure becomes more complicated and expensive. 
 
 In Germany, a district court banned the practice for young boys, but said older consenting males could have the procedure, sparking an outcry among Muslim and Jewish groups. The country's parliament later upheld the right to religious circumcision. (Editing by Christine Soares and Michele Gershberg; desking by Andrew Hay) 

 Much of the debate over routine infant circumcision has centered on the ethics of the procedure, in which a male's foreskin is removed. 
 
 But a new study published Monday by health economists with the Johns Hopkins University School of Medicine shifts the focus toward money. It says that if circumcision rates were to decline to the 10 percent level currently seen in Western Europe, it could add up to $505 million annually in direct health care costs. 
 
 "This is the first study ever conducted in the U.S. that has looked at the economic costs [of circumcision]," study author Dr. Aaron Tobian, a health epidemiologist and pathologist with Johns Hopkins, told The Huffington Post. "We believe that state Medicaid and private insurers should assess these data and recognize not only the medical benefits [of circumcision], but also the financial impact of denying coverage." 
 
 Rates of male circumcision have dropped significantly in the past several decades, from 79 percent of baby boys born in the 1970s and 80s to approximately 55 percent by 2010, the study said. They estimate that for every year the male circumcision rates are at that level, the U.S. health care system can expect to pay $211 million more than it would have had rates remained at that 79 percent peak. Over a 10-year period, that would equal about $2 billion in avoidable health care costs. 
 
 And if rates were to fall to 10 percent, or what they currently are in Europe where insurance coverage for routine circumcision is rare, lifetime health care costs would increase by approximately $400 per male and $40 per female, the researchers said. Over the next decade, that would equal approximately $4.4 billion. 
 
 "These are conservative estimates," Tobian said. "We only assessed direct medical cost. It does not include indirect [costs], such as patient or caregiver productivity lost." 
 
 Most of the money would be spent on treating sexually transmitted infections, the authors said. 
 
 But opponents to male circumcision, sometimes called "intactivists," argue that the health benefits of routine male circumcision are unproven. Georganne Chapin, founding executive director of the advocacy group Intact America, called some of the figures in the new study "trash." 
 
 "They have no evidence -- because there isn't any -- to back up these figures," Chapin said in a statement. "Commonwealth and European countries where male circumcision is rare have equal-to or better health status than the U.S." 
 
 Over the last several years, randomized trials in Africa have tied male circumcision to decreased risk of HIV infection as well as human papillomavirus (HPV), which can increase risk of cervical and other types of cancer. A 2010 trial, on which Tobian was an author, concluded that circumcision lowered the risk of genital herpes. 
 
 In the new study, published online in the Archives of Pediatric Medicine, Tobian and his colleagues estimated that if circumcision rates in the U.S. fell to 10 percent, the lifetime prevalence of HIV among men would increase by 12 percent, HPV by 29 percent, herpes type 2 by 20 percent and urinary tract infections by 212 percent. Women would also experience increases in sexually transmitted infections, such as bacterial vaginosis, a type of vaginal inflammation, and trichomoniasis, which is caused by a parasite. 
 
 "Documentation that male circumcision not only reduces the burden of STIs [sexually transmitted infections] for both men and women but also reduces lifetime treatment costs should provide compelling arguments in favor of infant male circumcision," wrote Arleen Leibowitz, an economist and professor of public policy and Katherine Desmond, a statistician, both with the University of California Los Angeles in an editorial accompanying the findings. 
 
 Medicaid programs in 18 states in the U.S. currently do not provide coverage for routine circumcision of baby boys, and local governments in California attempted to pass bans on the practice, but those attempts were blocked by Gov. Jerry Brown last fall. 
 
 Parents and health experts now have their eyes trained on the American Academy of Pediatrics, which will release its new circumcision policy statement at the end of August. Since 1999, that group has said that there is existing scientific evidence that demonstrates the "potential" medical benefits of newborn male circumcision, but not enough to recommend it routinely.
– American health care costs could be snipped significantly if the fall in circumcision rates was reversed, a new study claims. Around 55% of baby boys in the US are circumcised (down from 79% three decades ago), and 18 states have reduced funding for the procedure. If levels fall to Europe's 10%, it would cost the health-care system $4.4 billion over a decade to treat the projected rise in urinary tract infections in babies and HIV infections in men, the researchers say. "The state governments think we can save a few bucks, but it ends up costing them more in the long run," the lead researcher tells Reuters. A circumcision costs insurers up to $300, but extra health care costs will average $313 for every "foregone" circumcision, according to the researchers, who based their estimates on a recent study in Uganda. The chief of the anti-circumcision group Intact America, however, argues that the figures in the study are "trash" and the health benefits of male circumcision are unproven. "Commonwealth and European countries where male circumcision is rare have equal-to or better health status than the US," she tells the Huffington Post.