Cost but not convenience plays a significant role in attitudes about vaccination for common human papillomaviruses for women over the age of 26, according to the authors of a recent article in the journal Sexual Health.
Currently, the two vaccines for human papillomavirus (HPV), which is the primary cause of cervical cancer, are U.S. Food and Drug Administration approved for females from 9 to 26 years of age. The vaccines, Gardasil (Merck and Co.) and Cervarix (GlaxoSmithKline) are under review by the FDA for an older population of women.
Researchers from Indiana University School of Medicine and Columbia University Medical Center surveyed 1,323 women between 27 and 55 years of age who represent a racial and demographic cross section of the United States to determine the willingness among adult women to be vaccinated.
"We have been involved for several years in research looking at the attitudes toward HPV vaccination and acceptance of vaccine," said senior author and co-principal investigator Gregory D. Zimet, Ph.D., professor of pediatrics and clinical psychology in the Section of Adolescent Medicine at the IU School of Medicine. "This project looked at an older population of women to determine their attitudes about HPV vaccination and what factors influenced their attitudes."
Researchers found moderately strong interest in receiving the vaccination if it is available free of charge, said first author Nathan W. Stupiansky, Ph.D., a fellow with the IU Department of Pediatrics, Section of Adolescent Medicine. As out-of-pocket costs increased, interest decreased for the vaccine, which typically costs $120 per dose and requires three doses.
The survey also queried women as to whether they would prefer receiving the vaccine at a doctor's office or a local pharmacy to gauge if convenience played a factor in acceptance. The preferred choice by a slight edge was a doctor's office.
Factors that did not increase interest in the vaccine included having a friend or relative who had cervical cancer or personally having had a prior sexually transmitted infection.
Increased acceptibility was found in women who had experienced a genital warts outbreak, had at least one abnormal Pap test, previously had heard about the HPV vaccine or who had had a flu shot within the past two years.
"With the accumulating empirical evidence that vaccination of women over the age of 26 can be beneficial, it is important to understand specific factors associated with HPV vaccine acceptability," said Dr. Stupiansky. "This study clarifies some of the issues for acceptance including cost and prior knowledge of the vaccine.
The findings of the research also suggest that interest in the vaccine among adult women may be substantially dampened if insurance coverage does not reduce the out-of-pocket costs of HPV vaccination. Health insurance and/or public financing (the Vaccine for Children Program) covers HPV vaccination costs for virtually all females 9 through 17 years of age.
HPV is the most common sexually transmitted infection in the U.S. and can be found in more than 25 percent of all women aged 14 to 59 years. The highest rates are among women between the ages of 20 and 24 years but remain above 25 percent for women up to age 49. An estimated 1.6 million new infections occur each year in women older than 26 years of age. HPV is responsible for all cases of cervical cancer and genital warts and is the cause of some cases of anal, throat, vulvar and vaginal cancers.
This study was supported by an investigator-initiated grant from Merck and Co.
- Nathan W. Stupiansky, Susan L. Rosenthal, Sarah E. Wiehe and Gregory D. Zimet. Human papillomavirus vaccine acceptability among a national sample of adult women in the USA. Sexual Health, 2010; 7 (3): 304 DOI: 10.1071/SH09127
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