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Dynamics of HPV vaccination initiation in Flanders, Belgium.
– Reported, January 24, 2013
We studied the dynamic patterns of HPV vaccination initiation in Flanders during the first 2.5 years after the introduction of the vaccines on the Belgian market, so before the HPV-vaccines were offered free of charge through the school-based vaccination system. During our period of analysis, the vaccines were partially reimbursed by the health insurance system. The reimbursement regime (Compulsory versus Supplementary insurance) varied over time, mainly depending on the age of the girls and the membership of a respective sickness fund. We used a Cox regression model with time constant and time varying predictors to determine factors affecting the hazard of HPV vaccination initiation.
There can be various reasons why the probability of HPV vaccination was higher under the Compulsory insurance as compared to the Supplementary insurance. Most likely the generosity of the system played an important role. The full price of the HPV vaccines was 130.22 euro per dose.
Under the Compulsory insurance the girl buying the vaccine only had to pay the non-refundable part of the price of the vaccine. Under the Supplementary insurance the girl had to first advance the full price of the vaccine, after which part of it was refunded. Further, there was also substantially more media attention and advertising (towards girls, their families and medical doctors) for the Compulsory insurance. These might have had an important influence on the uptake of the vaccine: it has been shown that mass media interventions can significantly affect various health behaviors.
Vaccination uptake was substantially lower among girls from lower socio-economic backgrounds. Such association between socio-economic status and adolescent vaccination has been found in other studies, too. Socio-economic differences in HPV vaccination uptake are particularly relevant since people with low SES have a higher risk of contracting cervical cancer . An obvious explanation might be the financial barrier caused by the co-payments. However, most likely other reasons have also played a role, such as a differential influence of media attention on people with different socio-economic backgrounds or advertising being more directed to certain categories of people. Free, school-based HPV vaccination, as organized in Flanders from September 2010 on, might help to overcome this problem. School vaccination programs are indeed considered as the best way to achieve good adolescent vaccination uptake. Evaluating the performance of school vaccination programs in Flanders with regard to socio-economic differences in vaccination uptake however remains difficult: socio-economic differences are found for some of the vaccines currently included in the school vaccination program, too, but these might be partially attributed to differences in the availability of documentation on vaccination at home, since studies have to rely on documentation available at home.
We studied determinants of HPV vaccination initiation in Flanders (Belgium). Despite the fact that during our period of analysis the initiative for vaccination lied with the girls, their family or the gynecologists/pediatricians/general practitioners (no organized setting), vaccination uptake was high for certain subcategories of girls. However, large socioeconomic differences were found. This suggests that school-based vaccination, as it was introduced in Flanders in September 2010 (although with the possibility to refuse the vaccine or to get vaccinated by a physician outside the school-based system), might be preferred. Future research could give more insight in the evolution of HPV vaccination uptake under this school-based system, as well as in the factors underlying the observed socioeconomic differences.
CREDITS:
Eva Lefevere,Niel Hens, Frank De Smet, and Pierre Van Damme
http://www.ncbi.nlm.nih.gov/
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