Evaluating societal preferences for the human papillomavirus vaccines using a discrete choice experiment

Objectives: The objectives of this thesis were to i) evaluate societal preferences for the Human Papillomavirus vaccines using a discrete choice experiment (DCE), ii) determine societal willingness to pay (WTP) for an additional protection for genital warts, iii) identify subgroups with different preferences and iv) determine the trade-offs between benefits and perceived risks. Methods: Participants from across Canada were recruited for the study with a sample representative of the Canadian population. They completed a choice-based questionnaire which required them to choose between different combinations of attribute levels. The attributes were: (1) lifetime risk of cervical cancer (CC) and genital warts (GW); (2) frequency of Pap smear testing; (3) need for vaccine booster; (4) target group to vaccinate (girls only or girls and boys); (4) frequency of side effects and (5) cost of the vaccine. A mixed effect logistic model was used to analyze the data. Results: The 1157 participants included in the analysis had a mean age of 44 years (SD=15), and 49% of them were females. About 79% had high school/trade school education, and 61% earned more than $55,000/year. About 46% of participants had children. Respondents had a strong relative preference to avoid a yearly Pap smear testing and the most preferred frequency was every 3 years. They preferred a vaccine that would give lifelong immunity, that is, there was a preference for not receiving the vaccine booster dose. Respondents were more likely to choose a vaccination and screening strategy that targeted both boys and girls rather than girls alone. On average, respondents had a WTP of 303 to administer the vaccine to both girls and boys and a mean WTP of $53 and $21 to avoid a 1% increase risk of cervical cancer and genital warts, respectively. To avoid a 1% risk of cervical cancer, respondents were willing to accept a 2.43% increase in the risk of genital warts Conclusions: Society agrees with the introduction of the HPV vaccination program, but would prefer a vaccination strategy which targets both boys and girls and among the two HPV vaccines, Gardasil® was preferred because of its ability to prevent genital wart infection.Pharmaceutical Sciences, Faculty ofGraduat