Willingness to pay for hepatitis B immunoglobulin among pregnant women in Enugu metropolis, South-East, Nigeria: a cross-sectional study

Abstract

BACKGROUND: Hepatitis B immunoprophylaxis reduces the rate of mother-to-child transmission of hepatitis B virus infection and has effectively reduced the global burden of the hepatitis B virus infection. However, the cost of hepatitis B immunoglobulin could be prohibitive hampering adequate utilization in pregnancy and childbirth. Cost may affect pregnant women's willingness to pay (WTP) for the immunoglobulin. The WTP for hepatitis B immunoglobulin has not been critically studied in Enugu, Nigeria. The objective of the study was to determine the willingness of pregnant women to pay for hepatitis B immunoglobulin and to identify the predictors of the level of WTP among pregnant women in Enugu, Nigeria. METHODS: A cross-sectional study that involved 379 pregnant women who were selected through a multi-stage sampling technique from the health facilities in Enugu between March and November 2019 was conducted. A structured pre-tested interviewer-administered questionnaire was used for data collection. The contingent valuation technique was utilized for eliciting values attached to hepatitis B immunoglobulin by the pregnant women while the bidding game technique was used to determine the maximum amounts the participants were willing to pay. Data were analyzed using SPSS version 23. A p-value of 0.05 was regarded as significant. RESULTS: Most respondents (86.2%) were willing to pay for the hepatitis B immunoglobulin. The mean maximum amount of WTP was ₦23178.34 (62.64 USD). The price of hepatitis B immunoglobulin (48.8%) was a major hindrance to WTP and 36.9% of the respondents believed that the government should pay for the vaccines. Predictors of the average WTP amount were the level of education (p = 0.038, AOR = 2.645 CI: 1.055-6.630), participants' husbands' occupation, and weekly expenditure on food items (P = 0.041; AOR = 3.828, CI: 1.055-13.893). CONCLUSIONS: The rate of WTP for hepatitis B immunoglobulin was 86.2%, however, the mean WTP amount was far below the market value of hepatitis B immunoglobulin. The major hindrance to WTP was the cost of the vaccine as most participants believed that the vaccine should be administered freely and financed by the government and its agencies. The predictors of willingness to pay were the participant's level of education, husband's occupation and weekly expenditure on food. TRIAL REGISTRATION: Not applicable.