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

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 (<i>p</i> &lt; .001), parents’ education level (<i>p</i> = .024), and perceived price barriers (<i>p</i> &lt; .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.

DTaP-HBV-IPV-Hib六联疫苗（DTaP-HBV-IPV-Hib hexavalent vaccine）已在高收入国家应用多年，用于预防白喉、破伤风、百日咳、乙型肝炎、脊髓灰质炎及b型流感嗜血杆菌侵袭性疾病。目前，中国尚无获批上市的六联疫苗。针对六联疫苗的家长接受度与使用意愿相关证据，可为政策制定者与疫苗生产商进入中国疫苗市场、调整国内免疫规划提供决策支持。本研究通过评估家长对六联疫苗的接受度及支付意愿（willingness-to-pay, WTP），以期提供此类实证数据。我们于2023年4月28日至6月30日期间，针对中国7个城市的16家预防接种门诊的儿童照护者开展横断面调查，收集其社会人口学特征、疾病认知水平、疫苗接种信心、既往接种经历，以及对六联疫苗的接受意愿与支付意愿相关信息。采用多因素logistic回归分析影响疫苗接受度的因素，采用多因素tobit回归分析影响支付意愿的相关因素。本次调查共纳入581名0~6岁儿童的家长，其中435名（74.87%，95%置信区间：71.3%~78.4%）家长表示愿意接种六联疫苗。居住地区、家长受教育程度、自费接种经历及疾病认知得分，是影响家长疫苗接种选择的关键因素。该疫苗全程4剂次接种的平均支付意愿（标准差）与中位数（四分位间距）分别为2266.66（1177.1）元人民币与2400（1600~2800）元人民币。儿童年龄（p<0.001）、家长受教育程度（p=0.024）及感知价格障碍（p<0.001）均与支付意愿显著相关。家长对六联疫苗的接受度与支付意愿均处于较高水平。家长自付接种费用越低，其疫苗接受意愿越强。因此，若该疫苗被纳入医保报销范围、由政府免费提供或下调售价，其接受度有望进一步提升。本研究结果可为中国优化调整免疫策略提供参考依据。