A Behavioral Economic Approach to Improving Human Papillomavirus Vaccination

Abstract

PurposeThe objectives of this study were to measure the impact of a behavioral economic intervention on human papillomavirus (HPV) vaccine initiation and series completion rates for adolescents and to measure the impact of the intervention on the receipt of a nonincentivized influenza vaccine. MethodsWe conducted a quasi-randomized trial to compare the impact of an escalating delayed cash incentive (intervention), compared with usual care (control), on HPV vaccination initiation and series completion rates among adolescents (11–17 years) at an urban medical center. We measured HPV vaccine initiation and completion rates during the 12 months after enrollment and subsequent influenza vaccination rates for 24 months after enrollment. ResultsA total of 85 participants were actively enrolled in the intervention arm and 103 were passively enrolled in the control arm. Participants were predominantly publically insured African-American and Hispanic adolescents. The majority (75%) of the intervention group received one or more doses of the HPV vaccine, with 36% completing the three-dose series, compared with 47% of the control group receiving one or more doses and only 13% completing the series. The odds of HPV p-value vaccine initiation (odds ratio 4.19 [95% confidence interval 1.84–10.10], p < .01) and HPV vaccine series completion (OR 4.16 [95% confidence interval 1.64–11.28], p < .01) were greater among the intervention group compared with the control group. There was no difference in influenza vaccination rates between the intervention group and the control group during the 2013–2014 season (p = .138) and during the 2014–2015 influenza season (p value .683). ConclusionsAn incentive-based approach to HPV vaccination was effective in increasing vaccine initiation and series dose completion.