Willingness-To-Pay for Vaccines in Low- and Middle-Income Countries: A Systematic Review

Objective: Willingness-To-Pay (WTP) values, which provide monetary measures of community preferences for vaccines, could help policy makers set priorities for the use of health resources in lowand middle-income countries. We conducted a systematic review of published studies of WTP for vaccines. Methods: A systematic search of MEDLINE and SCOPUS through December 2013 and selection process, following PRISMA guidelines, yielded 35 English-language studies (21 studies in lowand middle-income countries and 14 in high-income countries) that evaluated WTP for one or more vaccines, either existing vaccines or hypothetical vaccines for real diseases; studies of hypothetical vaccines for hypothetical diseases were excluded. All WTP values extracted were converted to 2012 international dollars (I$) for comparability. Results: Although no time limit was placed on the search, all the studies were published after 2001. Reporting of methods was incomplete in many studies, with details on question wording, sampling method, response rate, and sometimes even currency year, lacking. Stated preference methods based on surveys were used for 34 studies; only one used a revealed preference method. Studies were available for 14 vaccines, but 22 studies focused on only five of those – vaccines for cholera, typhoid fever, HIV/AIDS, malaria, and influenza. WTP varied widely, from less than I$100 per capita for cholera and typhoid vaccines to more than I$1000 for a vaccine against HIV/AIDS. Conclusion: WTP varies widely across diseases in lowand middle-income countries, with consumers willing to pay substantially more for vaccines against chronic diseases with high mortality and morbidity, such as HIV/AIDS. More complete and standardized reporting would make these estimates more informative for policy makers in these countries as they set priorities for health in the face of limited resources.