Acceptance and willingness to pay for DTaP-HBV-IPV-Hib hexavalent vaccine among parents: A cross-sectional survey in China

Abstract

DTaP-HBV-IPV-Hib hexavalent vaccine has been used in high-income countries for many years to prevent diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis, and invasive Haemophilus influenzae type b disease. Currently, no hexavalent vaccines have been approved for use in China. Evidence of parental acceptance and interest in hexavalent vaccines can help policy makers and manufacturers make decisions about entering the vaccine market and the immunization program in China. We measured parental acceptance and willingness-to-pay (WTP) for a hexavalent vaccine to provide such evidence. We conducted a cross-sectional survey of children’s caregivers in 16 vaccination clinics in seven cities in China and obtained information on socio-demographics, knowledge of disease, confidence in vaccines, previous vaccination experience, and acceptance of and WTP for hexavalent vaccine. Multivariate logistic regression was used to determine factors influencing acceptance, and multivariate tobit regression was used to identify factors impacting WTP. Between April 28 and June 30, 2023, a total of 581 parents of children aged 0–6 years participated in the survey; 435 (74.87%, 95% CI:71.3%−78.4%) parents indicated acceptance of hexavalent vaccine. Residence location, parents’ education level, experience paying for vaccination, and disease knowledge scores were key factors affecting parents’ choices for vaccination. Mean (SD) and median (IQR) willingness to pay for full 4-dose course vaccination were 2266.66 (1177.1) CNY and 2400 (1600–2800) CNY. Children’s age ( p < .001), parents’ education level ( p = .024), and perceived price barriers ( p < .001) were significantly associated with WTP. Parents have high acceptance and willingness to pay for hexavalent vaccine. The less money parents have to pay out of pocket, the more willing they can be to accept the vaccine. Therefore, acceptance may increase even further if the vaccine is covered by medical insurance, provided free of charge by the government, or if its price is reduced. Our results provide reference for optimizing and adjusting immunization strategies in China.

Financial hindrances to introducing higher-valent pediatric combination vaccines

“…I read with interest the article ‘‘Acceptance and willingness to pay for DTaP-HBV-IPV-Hib hexavalent vaccine among parents: a cross-sectional survey in China’’ by Huang et al 1 The authors highlighted the importance of introducing higher-valent pediatric combination vaccines into national immunization programs to improve vaccine acceptance, so as to harness their advantages over lower-valent vaccines. These advantages include requiring fewer injections, which can potentially reduce indirect costs and increase completion and compliance rates.…”

“… 2 However, the direct costs of higher-valent vaccines can be higher. Thus, empirical evidence 1 on the need for sustainable immunization financing models is paramount for effective policy-making to realize equitable protection. The recent setbacks in childhood immunization in the context of the coronavirus disease 2019 pandemic, which increased the prevalence of and inequity in zero-dose and missed-dose children, 3 makes research on immunization financing even more valuable.…”

“…This may be the case for the authors’ study, as suggested by the results of the Tobit model indicating no significant association between monthly income and WTP. 1 …”

“…This can hinder the interpretation of WTP, thereby lessening its public health applicability and value for SDGs. In their analysis of WTP based on the payment card method, the authors 1 considered the direct costs of the hexavalent vaccine but did not include additional costs that a vaccination entails. However, if the indirect costs are substantial, they can also pose a substantial weight on the parents’ WTP for the vaccination.…”