title: Parental and societal values for the risks and benefits of childhood combination vaccines.
abstract: BACKGROUND
  New combination vaccines reduce the number of injections needed for immunization. However, possible drawbacks include higher prices, extra doses of vaccine antigens and increased minor adverse events. Our objective was to measure parental and societal values for attributes of childhood combination vaccines.
  
  
  METHODS
  We conducted a discrete choice experiment using an online survey of adults administered by Knowledge Networks. Values were measured for attributes of combination vaccines for a hypothetical child aged 6 months: (1) number of injections, (2) extra dose of hepatitis B vaccine, (3) 20% higher chance of fever, (4) community-level immunization coverage of 2-year-olds of 90% or 80%, and (5) cost per visit. Logistic regression with generalized estimating equations was used to analyze the value of different attributes and generate a marginal willingness-to-pay for a change in attribute level.
  
  
  RESULTS
  The response rate was 64% (N=558). Most respondents were parents (63%) and most respondents agreed that combination vaccines were safe (77%). Respondents were willing to pay $7.68 to avoid an injection (compared to $9.94 when looking at parents only). However, respondents were willing to pay $41.57 to avoid higher risk of fever after one set of immunizations (10% versus 30%) and $65.42 for higher immunization coverage rates. These results were very similar for parents only. There was no significant preference to avoid an extra dose of hepatitis B vaccine.
  
  
  CONCLUSIONS
  Respondents were willing to pay larger amounts to avoid increased risk of minor adverse events and to increase community-level immunization coverage than to avoid injections. These values should be taken into account when determining the risks and benefits of combination vaccines.
authors.affiliation: Harvard Pediatric Health Services Research Fellowship, Boston, MA, United States. gidengil@rand.org
authors.forename: Courtney
authors.initials: C
authors.lastname: Gidengil
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
authors.forename: Katherine
authors.initials: K
authors.lastname: Payne
authors.forename: Donna
authors.initials: D
authors.lastname: Rusinak
authors.forename: Mark
authors.initials: M
authors.lastname: Messonnier
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Prosser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000191:economics / Q000379:methods*; D017778:Vaccines, Combined / Q000008:administration & dosage / Q000191:economics / Q000276:immunology; D055815:Young Adult
chemical_list: D017778:Vaccines, Combined