Objectives

To systematically review, appraise and evaluate available evidence regarding discrete-choice experiments (DCEs) for the human papilloma virus (HPV) vaccination in order to support policymakers in making reasonable and effective vaccination program implementation decisions.

Methods

A systematic literature review was conducted using the databases PubMed and Embase for DCEs in HPV up to May 2019. Extracted data was tabulated and two checklists were used for the quality appraisal of the included studies. All attributes were categorized in outcome, process or costs attributes and the relative importance of attributes was calculated using the range method.

Results

Out of 164 identified studies, 12 met the inclusion criteria. Eight were from high income countries (HICs) and four from low and middle-income countries (LMICs). Five studies each examined vaccinee and parent preferences, while only two assessed the providers’ preferences. The studies were rather heterogenous in terms of the populations investigated, the attributes included and the methodologic approach. Overall, outcome measures were the most prominent attributes and effectiveness consistently yielded high relative importance scores. But also process factors, such as the age at vaccination, played an important role for decision making. Discrepancies between HICs and LMICs were most prominent for cost attributes.

Conclusion

The heterogenous preferences this review elicited highlight the importance of context when making decisions grounded on consumer preferences. Especially the lack of evidence from LMICs, where the burden of cervical cancer is highest, is worrisome. In order to increase uptake, close vaccination gaps and reduce current inequities in (reproductive) healthcare, policy makers need to understand the features that drive individual vaccination decisions and adapt national and clinical guidelines accordingly. Future research therefore needs to focus on LMICs in order to elicit preferences of those most vulnerable populations.

中文翻译：

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父母，提供者和疫苗接种者对HPV疫苗的偏好：离散选择实验的系统综述

目标

要系统地审查，评估和评估有关人乳头瘤病毒（HPV）疫苗的离散选择实验（DCE）的可用证据，以支持决策者制定合理有效的疫苗接种计划实施决策。

方法

截至2019年5月，使用PubMed和Embase数据库对HPV中的DCE进行了系统的文献综述。对提取的数据进行制表，并使用两个清单对所纳入研究的质量进行评估。所有属性都按结果，过程或成本属性分类，并且使用范围方法计算属性的相对重要性。

结果

在164项确定的研究中，有12项符合纳入标准。八个来自高收入国家（HIC），四个来自中低收入国家（LMIC）。五项研究各自检查了疫苗接种者和父母的偏好，而只有两项评估了提供者的偏好。就所调查的人群，所包括的属性和方法论方法而言，研究是异类的。总体而言，结果度量是最突出的属性，有效性始终产生较高的相对重要性得分。但是，诸如疫苗接种年龄之类的过程因素在决策中也起着重要作用。HIC和LMIC之间的差异在成本属性上最为突出。

结论

这篇评论引起的异类偏好突出了基于消费者偏好做出决策时环境的重要性。特别是缺乏LMIC的证据令人担忧，因为LMIC在宫颈癌的负担最大。为了增加摄入量，缩小疫苗接种差距并减少当前（生殖）医疗保健方面的不平等现象，政策制定者需要了解推动个体疫苗接种决定的特征，并相应地调整国家和临床指南。因此，未来的研究需要集中在低收入和中低收入国家上，以便引起那些最脆弱人群的偏好。