Research Article: Willingness to pay for hepatitis B vaccination in Selangor, Malaysia: A cross-sectional household survey

Date Published: April 9, 2019

Publisher: Public Library of Science

Author(s): Yogambigai Rajamoorthy, Alias Radam, Niazlin Mohd Taib, Khalid Ab Rahim, Subramaniam Munusamy, Abram Luther Wagner, Mudatsir Mudatsir, Abdullatif Bazrbachi, Harapan Harapan, Emily A. Hurley.


In Malaysia, one million individuals are estimated to be infected with the hepatitis B virus. A vaccine for infants has been compulsory since 1989, whereas those born before 1989 need to spend their own money to be vaccinated in private clinics or hospitals. The aim of this study was to investigate and ascertain the determinants of willingness to pay (WTP) for adult hepatitis B vaccine in Selangor, Malaysia.

In 2016, 728 households were selected through a stratified, two stage cluster sample and interviewed. Willingness to pay for hepatitis B vaccine was estimated using the Contingent Valuation Method, and factors affecting WTP were modelled with logit regression.

We found that 273 (37.5%) of the households were willing to pay for hepatitis B vaccination. The mean and median of WTP was estimated at Ringgit Malaysia (RM)303 (approximately US$73) for the three dose series. The estimated WTP was significantly greater in those with higher levels of education, among Malays and Chinese (compared to others, predominantly Indians), and for those with greater perceived susceptibility to hepatitis B virus infection. Other factors–perceived severity, barriers, benefits and cues to action–were not significantly associated with WTP for adult hepatitis B vaccination.

Additional resources are needed to cover the households that are not willing to pay for hepatitis B vaccination. More awareness (particularly in regards to hepatitis B virus susceptibility) could change the national perception towards self-paid hepatitis B virus vaccination and increase hepatitis B vaccine coverage.

Partial Text

The World Health Organisation has estimated that, worldwide, 257 million people are living with hepatitis B virus (HBV). Chronic infection can lead to HBV-related liver cirrhosis or hepatocellular carcinoma, which resulted in 887,000 deaths in 2015 [1]. Progression to chronic hepatitis B (HepB) is more pronounced when infants acquire HBV (with 80%-90% likelihood of chronic infection), compared to adults (with 5%-10% likelihood of chronic infection) [2, 3]. Nonimmune adults who are acutely infected could be important sources of HBV transmission.

Malaysia has intermediate-high levels of HepB endemicity. Current government prevention methods have focused on vaccinating infants, but infection in adults remains a large problem and will likely continue to increase in incidence over the next decade [8]. In a cross-sectional study in Selangor, Malaysia, we found that respondents were willing to pay RM303 (US$73) for three doses of HepB vaccine. Three sociodemographic factors (educational attainment, ethnicity and family income), along with perceived susceptibility to HBV infection, were all associated with WTP for HepB vaccination.

This study investigated WTP for HepB vaccination among Malaysians. On average, respondents were willing to pay RM303 (US$73) for HepB vaccination. Public awareness could be increased through programs such as public lectures at post-secondary institutions. Because ethnicity was also significant, brochures, awareness programmes, and public screenings on HepB could focus on specific communities, like Indians. Greater acceptance of HepB vaccination in the public could lead to greater acceptance of public funding mechanisms. Countering projected increases in the incidence of HepB disease in adults in Malaysia will require strategic planning to promote the vaccine, and will likely require campaigns to increase awareness of susceptibility to HBV infection or will require subsidies from the government to incentivize the public to vaccinate.