Financial and nonfinancial barriers to HPV vaccine utilization in young female California residents

The main goal of this research is to identify whether insurance coverage and poverty level have a significant and independent role in HPV vaccination rates of female residents of California. Two vaccines are designed to prevent HPV associated cervical cancer and are recommended for administration to girls 9-11 prior to onset of sexual activity. Young females 12-26 are recommended for catch up vaccination. Despite recommendations, the propensity to receive the vaccine depends on financial and nonfinancial barriers to vaccine utilization such as type of coverage and ability to pay for vaccination. At an estimated cost of $360 for the recommended three-dose vaccine and $92 for vaccine administration, the HPV vaccine is expensive. It is hypothesized that those with more comprehensive coverage and higher incomes are more likely to have received at least one dose of the HPV vaccine. We used the 2007 California Health Interview survey (CHIS). The outcomes of interest included whether the individual received at least one dose of the vaccine and those who completed the three dose series. The primary independent variables included insurance coverage defined as private-HMO, private non-HMO, public-HMO, public non-HMO, and uninsured. The private and public-HMO coverage was considered to be the most comprehensive form of coverage with the lowest level of cost sharing for the HPV vaccine. Federal poverty level (FPL) was also examined and was considered as a proxy for the individual's ability to pay for any HPV vaccine out-of-pocket costs. Logistic models were developed in SAS to estimate associations between the independent and dependent variables. Other characteristics of individuals including age, race/ethnicity, education level of self or parent, health status were included in the models as controls. The sample included 3,655 females ages 11 to 26. Overall, 16% had received at least one dose of the vaccine and 6% completed the series. In multivariate analysis, the poor (OR=0.66) and the uninsured (OR=0.36) were less likely to receive at least one dose compared to females above 300% of the FPL and those with private-HMO, respectively. The same variables predicted receipt of all three doses with the addition of those in public-HMOs who were less likely to complete the vaccine series compared to private-HMO insured. Females age 18 and older were less likely to have received the vaccine than younger females (OR=0.20). These findings support the contention that type of insurance coverage and ability to pay increases an individual's likelihood of being vaccinated.