title: Pediatricians' views on financial barriers and values for pneumococcal vaccine for children.
abstract: OBJECTIVE
  To 1) describe barriers to pneumococcal conjugate vaccine adoption and 2) estimate the value of the vaccine based on pediatricians' responses to willingness-to-pay questions.
  
  
  METHODS
  In June 2000, we mailed a random sample of pediatricians in Massachusetts a questionnaire about barriers to adoption of the vaccine and willingness to pay for the vaccine and associated outcomes. Respondents were assigned at random to 1 of 2 survey versions: the Personal Perspective version, for which they imagined spending their own money for their own child, or the Public Perspective version, for which they imagined spending the government's money for the average child.
  
  
  RESULTS
  Of the 546 pediatricians who responded (estimated completion rate, 80%), only 9% were using the vaccine routinely at the time of the survey. Most said that if the state did not provide the vaccine, financial barriers including inadequate insurance reimbursement would limit their use of the vaccine either a great deal (61%) or a moderate amount (25%). Pediatricians who were asked how much they would pay for the vaccine for their own child (personal perspective) gave a mean of $56 per dose, whereas those who were asked how much the government should pay on behalf of an average child (public perspective) gave a mean of $36 per dose. Alternatively, when we used a decision analysis model and incorporated pediatricians' values for preventing pneumococcal infections to estimate the vaccine's value, the value per dose was $38 from the personal perspective and $34 from the public perspective.
  
  
  CONCLUSIONS
  Pediatricians in Massachusetts identified significant financial barriers to the adoption of pneumococcal conjugate vaccine related to insurance arrangements. Based on willingness-to-pay questions, the value of the vaccine is lower than the current list price. The methods used to estimate the value of a vaccine, including the perspective used to frame questions, may substantially influence the results.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA. tracy_lieu@hphc.org
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Adams
authors.forename: Irina L
authors.initials: IL
authors.lastname: Miroshnik
authors.forename: Susan M
authors.initials: SM
authors.lastname: Lett
authors.forename: Sean
authors.initials: S
authors.lastname: Palfrey
authors.forename: Gary L
authors.initials: GL
authors.lastname: Freed
authors.forename: Ken
authors.initials: K
authors.lastname: Kleinman
authors.forename: G Thomas
authors.initials: GT
authors.lastname: Ray
authors.forename: Richard
authors.initials: R
authors.lastname: Platt
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D010372:Pediatrics / Q000191:economics*; D022242:Pneumococcal Vaccines / Q000191:economics*
chemical_list: D022242:Pneumococcal Vaccines