Hepatitis E Vaccination Preferences and Willingness-to-Pay Among Residents: A Discrete Choice Experiment Analysis

Objectives: Hepatitis E virus (HEV) infection is associated with severe hepatitis and high mortality rates, yet vaccination coverage remains suboptimal. Investigating public preferences for HEV vaccination is critical for developing targeted prevention strategies. This study employed a discrete choice experiment (DCE) to quantify attribute preferences and willingness-to-pay (WTP) for HEV vaccination among Chinese residents (in Shaanxi Province, for example), aiming to inform evidence-based immunization policy optimization. Methods: A cross-sectional survey recruited 3300 participants using stratified random sampling. The vaccine attributes-protective efficacy, duration of protection, and out-of-pocket cost-were identified using a systematic literature review and expert consultation. A comparative analysis of preference characteristics was conducted using conditional logit (Model 1) and mixed logit (Model 2) regression models. Population heterogeneity in vaccination preferences was further analyzed using the conditional logit framework, with marginal WTP estimated using parameter coefficients. Results: Among 3199 valid responses, duration of protection (Model 2: 10-years; β = 0.456, p < 0.001) and out-of-pocket cost (Model 2: 2000-3000 CNY; β = -0.179, p < 0.001) significantly influenced vaccination decisions. Preference heterogeneity was observed: women of childbearing age prioritized longer protection (10 years; β = 0.677, p < 0.001) and were sensitive to the cost of 1000-2000 CNY (β = 0.169, p = 0.011), while urban residents valued extended protection more than rural counterparts. Conclusions: Protection duration emerged as the primary determinant of HEV vaccination preference. Policy recommendations include implementing tiered pricing strategies and targeted health education campaigns emphasizing long-term protection benefits to enhance vaccine uptake and affordability.