title: Public health impact of Infanrix hexa™ (DTPa-HBV-IPV/Hib) reimbursement: A study programme in France. Part 2: Evolution of the acceptability of infants' vaccination against hepatitis B in general and pediatric practices - the PRALINE study.
abstract: BACKGROUND
  The reimbursement of the hexavalent vaccine (Infanrix hexa™), comprising the DTPa-IPV-Hib components and the hepatitis B recombinant in a single vaccine, was approved in France in March of 2008. The impact of its reimbursement on physicians' decisions to vaccinate infants against hepatitis B was assessed in a study conducted with general practitioners and pediatricians.
  
  
  METHODS
  The PRALINE study (NCT01777074) was a national, cross-sectional, repeated study with two measurement periods (T1 and T2) that measured the changes in physicians' acceptance of hepatitis B vaccination of infants before and for the 3 years after the approval of the hexavalent vaccine reimbursement. Two patient registers were created for each measurement period to enroll the first 15 12- to 15-month-old infants and the first 15 24- to 27-month-old children seen by the practitioners. The proportion of eligible children receiving a hepatitis B vaccine for each physician's practice was calculated. Practitioners also answered a vaccination practice questionnaire via telephone interviews.
  
  
  RESULTS
  Across the two study periods, 418 general practitioners and 463 pediatricians were recruited and responded to the telephone interview on their vaccination practices. The overall number of children included in the study in both study periods reached almost 20,000. In the general practitioners group, there was a significant increase in the proportion of physicians "practicing hepatitis B vaccination" (i.e., at least 50% of eligible children receiving the initial hepatitis B vaccination) in children 24-27 months old (79% T2 versus 47% T1, P-value [P]<0.001). Similarly, the proportion of pediatricians initiating hepatitis B vaccination increased from 51% (T1) to 94% (T2) (P<0.0001). General practitioners offered hepatitis B vaccination to infants more systematically in the second study period (87% T2 versus 73% T1, P<0.001) and also suggested the use of the hexavalent vaccine to more patients after reimbursement (92% T2 versus 78% T1, P<0.0001). The proportion of pediatricians offering vaccination to every infant was high at T1 (94%) and remained steady (97%) with a high use of the hexavalent vaccine (94% T1 and 96% T2).
  
  
  CONCLUSIONS
  The PRALINE study shows a significant and immediate change in the hepatitis B vaccination practices of general practitioners and pediatricians following hexavalent vaccine reimbursement with a significant increase in hepatitis B vaccine coverage in infants.
authors.affiliation: Association française de pédiatrie ambulatoire (AFPA), Commission scientifique, 67, rue Alexandre-Dumas, 73100 Aix-les-Bains, France. Electronic address: f.vielesage@fvls.fr.
authors.forename: F
authors.initials: F
authors.lastname: Vié le Sage
authors.affiliation: Assistance publique-Hôpitaux de Paris (AP-HP), service de pédiatrie générale, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France.
authors.forename: J
authors.initials: J
authors.lastname: Gaudelus
authors.affiliation: Institut national de la santé et de la recherche médicale (Inserm), centre de recherche en épidémiologie et santé (CESP), 14, avenue Paul-Vaillant-Couturier, 94807 Villejuif, France.
authors.forename: F
authors.initials: F
authors.lastname: Lert
authors.affiliation: Service de protection maternelle et infantile Paris, Direction des familles et de la petite enfance, 94/96, quai de la Râpée, 75570 Paris cedex 12, France.
authors.forename: V
authors.initials: V
authors.lastname: Dufour
authors.affiliation: Kappa Santé, 4, rue de Cléry, 75002 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Texier
authors.affiliation: Kappa Santé, 4, rue de Cléry, 75002 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Pouriel
authors.affiliation: Kappa Santé, 4, rue de Cléry, 75002 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Schück
authors.affiliation: GSK, PharmacoEpidémiologie et modélisations médico-économiques, 100, route de Versailles, 78163 Marly-le-Roi, France.
authors.forename: B
authors.initials: B
authors.lastname: Tehard
authors.affiliation: Université Pierre-et-Marie-Curie, Institut national de la santé et de la recherche médicale (Inserm U1153), 53, avenue de l'Observatoire, 75013 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Bréart
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D005602:France / Q000453:epidemiology; D058006:General Practice / Q000191:economics / Q000706:statistics & numerical data; D018073:Haemophilus Vaccines / Q000191:economics* / Q000627:therapeutic use; D006509:Hepatitis B / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010372:Pediatrics / Q000191:economics / Q000706:statistics & numerical data; D011054:Poliovirus Vaccine, Inactivated / Q000191:economics* / Q000627:therapeutic use; D011634:Public Health / Q000191:economics*; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data; D017778:Vaccines, Combined / Q000191:economics / Q000627:therapeutic use
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D018073:Haemophilus Vaccines; D017325:Hepatitis B Vaccines; D011054:Poliovirus Vaccine, Inactivated; D017778:Vaccines, Combined; C541235:diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae b conjugate-hepatitis B vaccine
keywords: Acceptability; Acceptabilité; Couverture vaccinale; France; Hepatitis B; Hépatite B; Médecin; Physician; Public health; Reimbursement; Remboursement; Santé publique; Vaccine coverage