KEYWORD1:
Adult immunization, willingness-to-pay, Hepatitis A vaccine, Hepatitis B vaccine, equitable access to care

BACKGROUND:
Charging a fee to patients can assist sexually transmitted disease (STD) clinic’s total cost to support adult hepatitis A and B vaccination programs. However, it is important to know whether cost will be an issue to those most at risk and how varying charges would affect expected vaccination coverage levels.

OBJECTIVE:
To examine men who have sex with men (MSM) attending a STD clinic’s willingness-to-pay (WTP) for hepatitis A and B vaccinations and to identify factors associated with the WTP response.

METHOD:
As part of a demonstration project, HAV and HBV vaccinations were offered at no cost to STD clinic patients. Consenting patients were asked in a self-administered questionnaire how much would they be willing to pay for the HAV and HBV vaccines if they were not free. Discrete choice responses included: $0, $10, $15, $25, and $45 per dose. Continuation-ratio logistic regression was used to analyze the results.

RESULT:
Overall, approximately 15% of MSM patients reported WTP of $0; 69% of those responding WTP of $0 reported incomes of less than $15,000 (including no income). Consistent with the literature, lower income was associated with lower WTP. After controlling for income, participants who agreed to “Not worried about getting the HAV disease” had lower WTP and participants who agreed to “HAV disease is serious enough to worry” had higher WTP associated with the HAV vaccine [OR Not worried about getting the HAV disease 0.86 (0.78, 0.96); OR HAV disease is serious enough to worry 1.14 (1.03, 1.26].

CONCLUSION:
If STD clinics charge a fee, it is important that program planners consider ways to provide vaccinations to the extreme disadvantaged to ensure complete vaccination coverage. Donation-request only may be a sufficient alternative.
LEARNINGOBJECTIVES:
To have participants understand willingness-to-pay for hepatitis A and hepatitis B vaccinations among men who have sex with men attending a sexually transmitted disease clinic.