Expensive Health Research Articles

Using Drosophila to identify inhibitors of oxalate kidney stone formation

BackgroundKidney stones are an expensive and painful health problem with calcium oxalate (CaOx) being 70% of cases. We developed a Drosophila model of CaOx stones [Hirata et al., AJP‐Renal Physiol, 2012]. This work showed that dPrestin (Slc26a5/a6) exchanges Cl− for oxalate (Ox). Thiosulfate (S2O3) and tannic acid (TA) are implicated to inhibit CaOx crystals in supersaturated urine. Here, we report transporter, renal tubule and whole body effects of S2O3 and TA on crystal formation.MethodsS2O3 and TA transport effects were examined by voltage clamping of dPrestin‐expressing Xenopus oocytes. Cis‐inhibition of oxalate transport was also examined in (a) dissected Malpighian tubules (MT) or flies fed ox‐enriched food plus S2O3 or TA. MT CaOx crystals were viewed by DIC, or whole flies by microCT.ResultsdPrestin transports S2O3 but not TA, yet both inhibited Ox transport (Ki(S2O3)~10mM; Ki(TA)~100μM). S2O3 competitively inhibits while TA blocks dPrestin. MT treated with S2O3 or TA ↓ crystal formation compared to MT soaked in Ox only. Flies fed with S2O3 or TA also showed ↓ CaOx in MTs.ConclusionsS2O3 and TA are both inhibitors of CaOx crystallization. These experiments show that these inhibitors have distinct mechanisms of action. Our Results indicate that (a) this Drosophila model can be used as a chemical screening assay for CaOx stone prevention and (b) TA, due to low Ki, might be a reasonable therapy for certain CaOx stones patients.[DK83007, DK92408]

Poliomyelitis eradication: Rhetoric or reality

Since the launch of Global Polio Eradication Initiative in 1988, disease burden has been reduced by more than 99% globally. Lately, India has witnessed a year without a case of poliomyelitis. It no longer stands endemic and is being regarded as a model for polio eradication efforts in other low income endemic countries: Pakistan, Nigeria and Afghanistan. The near elimination of wild polio virus in India has set forth new challenges of vaccine derived polio virus and need for newer strategies in oral poliomyelitis vaccine cessation preparatory phase. Stricter surveillance measures are needed to check for importations, any spread of virus in migratory populations and rapid containment of newly found virus. No stone should be left unturned in this last ditch effort for extermination of polio virus form environmental circulation. India's battle against polio will be cited as the biggest public health achievement or the most expensive public health failure.

Health care for some: rights and rationing in the United States since 1930

The 2010 Affordable Care Act (or Obamacare, as its detractors like to call it) is a sweeping reform to the US health care system. Despite the fact that nearly every other developed country in the world considers health care a right, the passage of the act in the United States was hard fought, due to a staunch and vocal opposition to universal health care among many American lawmakers. Why has the United States been so continually divided on this issue? In Health Care for Some, Beatrix Hoffman offers an explanation in the form of an engaging and in-depth look at America's long tradition of unequal access to health care. Hoffman argues that two main features have characterized the US health system: a refusal to adopt a right to care and a particularly American type of rationing. Health Care for Some shows that the haphazard way the US system allocates medical services - using income, race, region, insurance coverage, and many other factors - is a disorganized, illogical, and powerful form of rationing. And unlike rationing in most countries, which is intended to keep costs down, rationing in the United States has actually led to increased costs, resulting in the most expensive health care system in the world. While most histories of US health care emphasize failed policy reforms, Health Care for Some looks at the system from the ground up in order to examine how rationing is experienced by ordinary Americans - from soldiers' pregnant wives to survivors of Hurricane Katrina - and consequently reveals how experiences of rationing have led to claims for a right to health care. The story of the Affordable Care Act is still being written, and its ultimate success or failure has yet to be determined. To understand how we got here and what might be to come, you could have no better primer than Health Care for Some.

Prevalence of pressure ulcers in hospitals in Brazil and association with nutritional status—A multicenter, cross-sectional study

BackgroundPressure ulcers (PU) represent a widespread, painful, and expensive health care problem directly associated with increased morbidity, mortality, and length of hospital stay. The aim of this study was to determine the prevalence of PU in hospitalised patients in public and private Brazilian institutions and the ulcers’ associations with nutritional status and other risk factors. MethodsA multicenter, cross-sectional, quantitative and qualitative study was carried out in hospitals in different geographic regions of Brazil from March 2009 to February 2011. The prevalence and characteristics of PU, the nutritional status and the association between the presence of PU, and the nutritional status and other study variables were evaluated. The association of the presence of PU with the study variables was performed by univariate analyses and multivariate logistic regression models. The final multivariate model was one in which all variables were significant at the 0.05 level. ResultsAccording to the subjective global assessment (SGA), the prevalence of PU was 16.9%, and 52.4% of patients were malnourished. PU and their severity were directly associated with malnutrition (P < 0.05). Patients who are bedridden, who are elderly, who have neurological disorders or cancer, who are staying at a public or private institution, and who are staying at the hospital between 8 d and 15 d had an increased risk of PU (P < 0.05). ConclusionThe prevalence of PU in Brazilian general hospitals is high, and the prevalence of malnutrition is extremely high. Malnourishment is one of the most important risk factors associated with the development and severity of PU in hospitals. Patients who are malnourished are more prone to developing PU.

The Novel Image of Pharmacist of a Super-aged Society in Japan

The percentage of the population over age 65 in Japan was greater than 23% in 2010. Therefore, Japan is the world's first "super-aged society", and our country needs a new regional health care system. Our medical systems face many challenges, such as this increase in elderly population with chronic diseases, maintenance of universal health insurance and free access to hospitals, and expensive health care costs. It is not easy to change the current health care system without a sufficient number of doctors. On the other hand, Japan's curriculum in pharmaceutical education has been expanded to six years to establish a new profession of pharmacist. Rapid progress in the market of pharmacies in accepting prescriptions since 1974 has caused pharmacists to primarily act as "technicians". But this is not the best way to solve the serious problems of Japanese medical systems. I want to present the image of a next-generation pharmacist (Pharmacist 3.0), to be involved in the idea of collaborative drug therapy management (CDTM) in this article. The total optimization of our medical supply system with all medical and pharmaceutical specialists is necessary in Japan.

Prevention of patient falls – A case study

Fall-related injuries can be some of the most common, disabling, and expensive health conditions encountered by adults, especially older adults. According to researcher Janice Morse, approximately 14% of all falls in hospitals are accidental, another 8% are unanticipated and 78% are anticipated falls. Guideline to prevent falls in the hospital has helped to bring down the numbers and improve patient safety.

A matched-pair cluster-randomized trial of guided care for high-risk older patients.

Patients at risk for generating high health care expenditures often receive fragmented, low-quality, inefficient health care. Guided Care is designed to provide proactive, coordinated, comprehensive care for such patients. We hypothesized that Guided Care, compared to usual care, produces better functional health and quality of care, while reducing the use of expensive health services. 32-month, single-blind, matched-pair, cluster-randomized controlled trial of Guided Care, conducted in eight community-based primary care practices. The "Hierarchical Condition Category" (HCC) predictive model was used to identify high-risk older patients who were insured by fee-for-service Medicare, a Medicare Advantage plan or Tricare. Patients with HCC scores in the highest quartile (at risk for generating high health care expenditures during the coming year) were eligible to participate. A registered nurse collaborated with two to five primary care physicians in providing eight services to participants: comprehensive assessment, evidence-based care planning, proactive monitoring, care coordination, transitional care, coaching for self-management, caregiver support, and access to community-based services. Functional health was measured using the Short Form-36. Quality of care and health services utilization were measured using the Patient Assessment of Chronic Illness Care and health insurance claims, respectively. Of the eligible patients, 904 (37.8 %) gave written consent to participate; of these, 477 (52.8 %) completed the final interview, and 848 (93.8 %) provided complete claims data. In intention-to-treat analyses, Guided Care did not significantly improve participants' functional health, but it was associated with significantly higher participant ratings of the quality of care (difference = 0.27, 95 % CI = 0.08-0.45) and 29 % lower use of home care (95 % CI = 3-48 %). Guided Care improves high-risk older patients' ratings of the quality of their care, and it reduces their use of home care, but it does not appear to improve their functional health.

Cyberhugs: Creating a Voice for Chronic Pain Sufferers Through Technology

Chronic pain is a pervasive and expensive public health problem affecting roughly one-third of the American population. The inability of language to accurately convey pain expressions combined with the social stigmas associated with discussing pain persuade many sufferers to remain silent about their pain. Gender politics and fear of professional repercussions further encourage silence. This article explores the need for a safe and secure place for chronic pain sufferers to talk of their pain experiences. The extent to which digital communication technology can fulfill this need is examined. This descriptive study examines the use of one online chronic pain management workshop for its ability to create an engaged community of choice. Workshop admittance was based on participants having a qualifying chronic pain condition. A thematic discourse analysis is conducted of all entries chronic pain participants posted. In addition to goal setting, participants discuss the ways in which pain affects them on a daily basis. Two themes emerge: validation and encouragement. This study suggests that chronic pain users need a discursive space to legitimate their chronic pain identity. It confirms that online websites and virtual audiences facilitate disclosure and allow for authentic communication. The benefits of computer-mediated discussion as well as its limitations are examined.

Reflections on Leadership in Healthcare: The Past 50 Years

Leadership in the hospital sector has been characterized by a state of change since the early 1960s. Heavily influenced by the emergence of the principles of the Canadian health system, leadership at the time was shaped in many ways by the post-World War II construction boom. It was significantly impacted by the developing professional unions in the clinical professions and the resultant and conflicted labour relations of the 60s and 70s. The environment of leadership was in those days predominantely a transactional style, and was frequently confrontational. But the many leaders of Canada's hospitals were also characterized by a caring cadre of often-colourful personalities who challenged, debated and strove to ensure adequate funding and a harmony among the diverse clinical, community and political interests confronting their organizations. The major restructuring of an ever-more expensive health system has set the stage for substantial innovation and reform as the leaders in the system integrate new technologies, personalized pharmaceuticals, devolving scopes of practice and entrepreneurial opportunities related to incentive funding. The development of leadership competencies such as the Leaders for Life framework across the health workforce will be essential to successfully guide our health delivery system into the future.

Innovations in Care Delivery to Slow Growth of US Health Spending

THE UNITED STATES NEEDS TO SLOW ITS RATE OF growth in inflation-adjusted per capita health spending by 2.5 percentage points annually without sacrificing health or slowing biomedical technology advances. The consequences of failure may include shifting of funding away from resources for elementary and high school education, infrastructure (such as highways), and basic science research, as well as weakening the global competitiveness and financial health of US workers and their employers. One approach lies upstream—the prevention of disease by mitigating underlying environmental, social, and behavioral health risks. The most immediate progress is likely to come downstream from innovations that safely and compassionately lower health spending by reducing the cost of hospitalization for all patients and its unplanned occurrence for the 5% of individuals who incur half of health care expenditures in the United States. Opportunities include preventing expensive health crises among medically fragile patients, helping patients in late stages of serious illness avoid dying in a hospital, increasing patient flow through hospitals to lower average fixed cost per hospitalization, and reducing hospital readmissions.

Rethinking Federalism for More Effective Governance

For common reasons the federal government and most state governments face rising structural deficits even as the economy recovers. An aging population requires retirement income and increasingly expensive health care, while a prosperous economy requires public investment in skills, technology, and infrastructure. However, stressed federal and state tax systems are increasingly inadequate. The author revisits proposals, made twenty years ago, for substantial changes in fiscal federalism designed to help both levels function more effectively. She argues that the case for dividing the governmental job more sharply between the two levels is stronger than ever and explores the pros and cons of devolving elementary and secondary education to the states. She argues for common shared taxes, especially a broad-based federal consumption tax shared with the states.

Community Pharmacists' Impact on an Employer-Initiated Diabetes Disease Management Program

Background: Diabetes is the third most expensive physical health condition for US employers. Thus, there is a need for employers to engage in disease management programs for their diabetic employees in order to ensure long-term benefits. Objective: To evaluate the clinical outcomes of successful implementation of an employer-initiated pharmacist-based disease management program for diabetic patients. Methods: This was a longitudinal retrospective study analyzing clinical indicators in diabetic employees after a community pharmacist-based diabetes disease management (DDM) program in a rural setting. The program involved comprehensive drug therapy assessment and individualized disease management education. Outcomes measured in this study were fasting serum glucose (FSG) levels, glycated hemoglobin (A1C) levels, diastolic blood pressure (DBP), systolic blood pressure (SBP), body mass index (BMI), and complete lipid profiles including high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), and total cholesterol (TC) levels. Results: A total of 137 patients were enrolled in this program. Significant improvement in mean clinical outcome scores was achieved for FSG (p = 0.004), DBP (p = 0.018), and SBP (p = 0.044). At the end of the 1-year intervention, targeted FSG and A1C goals were attained by 39.1% (p = 0.029) and 39.4% of patients, respectively. Also, targeted DBP, SBP, BMI, LDL, HDL, TG, and TC levels were achieved by 54.8% (p &lt; 0.001), 38.5%, 38.3%, 56.8%, 38.2%, 37.5%, and 52.4% of patients, respectively. Conclusions: This study establishes a need for implementation of long-term employer-initiated pharmacist-based DDM programs that improve clinical outcomes for employees. Further studies evaluating outcomes for a longer time period would provide more conclusive results.

Help-Seeking for Emotional Problems in Major Depression

To study help-seeking among the general population and people with major depression. 12-month help-seeking for emotional problems was assessed in a cross-sectional 2006 Estonian Health Survey. Non-institutionalized individuals aged 18-84 years (n=6,105) were interviewed. A major depressive episode was assessed using the Mini-International Neuropsychiatric Interview. The factors associated with help-seeking, received help, and health service use were analyzed. The prevalence of 12-month help-seeking for emotional symptoms was 4.8%. The rate of 12-month help-seeking in the depressed sample was 34.1%. Depressed people used non-mental health services 1.5-3 times more than non-depressed persons even when adjusted for the chronic somatic disorder. Only one third of depressed persons sought help, which was most of all associated with severity of depression. Underdiagnosis and undertreatment of depression leads to an increased use of expensive but non-specific health services by depressed persons.

A systematic review of musculoskeletal disorders among school teachers

BackgroundMusculoskeletal disorders (MSD) represent one of the most common and most expensive occupational health problems in both developed and developing countries. School teachers represent an occupational group among which there appears to be a high prevalence of MSD. Given that causes of MSD have been described as multi-factorial and prevalence rates vary between body sites and location of study, the objective of this systematic review was to investigate the prevalence and risk factors for MSD among teaching staff.MethodsThe study involved an extensive search of MEDLINE and EMBASE databases in 2011. All studies which reported on the prevalence and/or risk factors for MSD in the teaching profession were initially selected for inclusion. Reference lists of articles identified in the original search were then examined for additional publications. Of the 80 articles initially located, a final group of 33 met the inclusion criteria and were examined in detail.ResultsThis review suggests that the prevalence of self-reported MSD among school teachers ranges between 39% and 95%. The most prevalent body sites appear to be the back, neck and upper limbs. Nursery school teachers appear to be more likely to report suffering from low back pain. Factors such as gender, age, length of employment and awkward posture have been associated with higher MSD prevalence rates.ConclusionOverall, this study suggests that school teachers are at a high risk of MSD. Further research, preferably longitudinal, is required to more thoroughly investigate the issue of MSD among teachers, with a greater emphasis on the possible wider use of ergonomic principles. This would represent a major step forward in the prevention of MSD among teachers, especially if easy to implement control measures could be recommended.

Making the Best of Hard Times: How the Nation's Economic Circumstances Shaped the Public's Embrace of Health Care Reform

The U.S. Congress enacted expansive (and expensive) health care reforms amid the worst economic downturn since the Great Depression. Public acquiescence provided crucial political cover; elites on both sides struggled mightily to sway popular opinion. Were reformers' efforts made easier or more difficult by the tough economic times? Using newly available data on Americans' perceptions of economic insecurity and attitudes toward public policy, this article explores the relationship between economic circumstances and political attitudes. The findings suggest that the Great Recession both facilitated and impeded efforts to rally the public in favor of reform: perceptions of past declines in the U.S. economy bolstered government intervention, but household economic insecurity both distracted attention from large medical expenses (which otherwise legitimized collective action) and undermined Americans' support for additional government spending. Equally consequential, reformers' efforts to adapt to economic stringency by portraying reform as exclusively about affordability missed opportunities for broadening popular support for these interventions; in the longer run this may, unless corrected, prove a decisive misstep in shepherding the Patient Protection and Affordable Care Act through its long time line of implementation.

An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer

There is growing enthusiasm for robotic-assisted laparoscopic operations across many surgical specialities, including colorectal surgery, often not supported by robust clinical or cost-effectiveness data. A proper assessment of this new technology is required, prior to widespread recommendation or implementation. The ROLARR trial is a pan-world, prospective, randomised, controlled, unblinded, superiority trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. It will investigate differences in terms of the rate of conversion to open operation, rate of pathological involvement of circumferential resection margin, 3-year local recurrence, disease-free and overall survival rates and also operative morbidity and mortality, quality of life and cost-effectiveness. The primary outcome measure is the rate of conversion to open operation. For 80% power at the 5% (two-sided) significance level, to identify a relative 50% reduction in open conversion rate (25% to 12.5%), 336 patients will be required. The target recruitment is 400 patients overall to allow loss to follow-up. Patients will be followed up at 30 days and 6 months post-operatively and then annually until 3 years after the last patient has been randomised. In many centres, robotic-assisted surgery is being implemented on the basis of theoretical advantages, which have yet to be confirmed in practice. Robotic surgery is an expensive health care provision and merits robust evaluation. The ROLARR trial is a pragmatic trial aiming to provide a comprehensive evaluation of both robotic-assisted and standard laparoscopic surgery for the curative resection of rectal cancer.

Appeals Court Rejects Health Reform Law's Insurance Mandate

Back to table of contents Previous article Next article Government NewsFull AccessAppeals Court Rejects Health Reform Law's Insurance MandateJonathan WolfeJonathan WolfeSearch for more papers by this authorPublished Online:2 Sep 2011https://doi.org/10.1176/pn.46.17.psychnews_46_17_5AbstractA federal appeals court has ruled unconstitutional the provision of President Obama's health care reform law that would require all U.S. citizens to purchase health insurance coverage beginning in 2014. This decision by the U.S. Court of Appeals for the 11th Circuit follows a previous ruling by the 6th Circuit Court of Appeals, which voted in favor of the "minimum coverage" mandate in June (Psychiatric News, August 5). The appellate courts' contradictory findings suggest that the Supreme Court will be forced to weigh in with a final determination on the constitutionality of the Patient Protection and Affordable Care Act. "The ruling by the 11th Circuit is a significant blow but by no means the death of health care reform," said Robert Cabaj, M.D., chair of APA's Council on Advocacy and Government Relations. "The action is likely to lead to a full Supreme Court review sooner than originally thought, and that is likely a good step." In a 2-1 decision rejecting the individual coverage provision, Chief Judge Joel Dubina and Circuit Judge Frank Hull ruled that a health insurance mandate is a violation of congressional authority under the Constitution's Commerce Clause. "This economic mandate represents... the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives," wrote Dubina. Despite the court's rejection of the Affordable Care Act's minimum coverage provision, Dubina and Hull ruled that the rest of the law is acceptable as written. This overturns the U.S. District Court for the Southern District of Florida's earlier ruling in the case, which deemed the individual mandate as not being severable from the rest of the law. The 11th Circuit's ruling is also notable in that Hull is a Democratic appointee of President Bill Clinton. Prior to the 6th Circuit's ruling in June, in which a Republican-appointed judge voted in favor of the mandatory insurance provision, federal court hearings on the Affordable Care Act resulted in decisions being made along the party lines of their respective judges. The suit was brought against the departments of Health and Human Services, Labor, and Treasury by the attorneys general of 26 states, as well as two private individuals and the National Federation of Independent Business. ISSUES NewArchived

Are you fit for purpose? The development of a competency framework for diabetes nursing in the UK

conditions from hospital outpatient clinics into primary care, 1 as this is perceived as more convenient to patients and, in particular, is less costly. Health care provision is now commissioned for a local population, with increasing emphasis on who gives the best value for money. For diabetes care, this means that some aspects of the service are being provided by a wider group of practitioners, some of whom may be unregistered, and some of whom may be outside the traditional National Health Service (NHS). It makes sense to delegate routine simple tasks to less qualified (and less expensive) health care staff and allocate complex care to those who have experience and qualifications (but who are more expensive); however, it may be difficult to identify who is competent to deliver the service required, and be assured that quality is maintained as well as at a competitive cost (i.e. best value). As diabetes care is delivered in a variety of environments including non-NHS, ensuring that people with diabetes are seeing the right people at the right time is a challenge. This article describes the development of a competency framework for diabetes nursing in the UK that defines various aspects of diabetes care and the competencies required to deliver these (i.e. what is expected) by different levels of registered and unregistered practitioners. The framework provides a career structure for nurses who wish to develop a diabetes specialism, and a commissioning tool for identifying the most appropriate staff that are required to provide a diabetes service. It can be helpful in business planning when justifying why more expensive staff are needed to perform a particular service and why resources are needed for training and development; it can also be a framework for providers of diabetes care to benchmark themselves and demonstrate their competency to deliver the service required. In the rest of Europe, a similar competency frame work may be useful in ensuring standardisation across different countries about what is expected in the provision of diabetes nursing, no matter in which country the care is delivered and by whom.

Invited commentary

As the population continues to age, vascular surgeons will continue to be confronted with the difficult problem of treating increasingly elderly patients. In this article, the authors address the issue of endovascular abdominal aortic aneurysm repair (EVAR) in nonagenarians, a population of patients clearly expected to increase in the coming decades. The data from their report can be used to both support and refute the wisdom of performing EVAR in patients in their ninth decade. Although procedural results were “acceptable,” to use the authors' word, perioperative morbidity (25%) and mortality (8.3%) were much higher than what we have come to expect from EVAR in the general population. Ultimately, >20% of the patients died as a direct result of the aneurysm or the repair, so it is not clear that EVAR in this patient group has improved the natural history of the disease. Furthermore, one has to question the wisdom of extending expensive health care resources to patients with limited life expectancy, only 19% at 5 years in this study. It must always be kept in mind that elective EVAR is a prophylactic operation for an asymptomatic condition. From a public health standpoint, it is questionable whether the cost/benefit ratio pencils out in this scenario. On the other hand, all vascular surgeons have seen and treated the “vigorous” nonagenarian whose health and quality of life defy their chronologic age. Although, as one of my mentors once told me, they may not look 90 before their operation, they always look 90 afterward. Clearly, though, there exists a subset of nonagenarians for whom EVAR is appropriate. Unfortunately, the numbers treated in this study were not large enough to stratify patients to determine factors predicting good and poor outcomes. Given the rarity of this procedure in nonagenarians, it is unlikely that a single center would be able to do so, and pooled data from multiple centers may be necessary to answer this question and identify nonagenarians for whom this procedure is most appropriate. The authors are to be congratulated for critically analyzing and presenting their results in this difficult group of patients. The conclusions are open to debate, and this article does not provide a definitive answer; however, it does serve as a point of comparison for future studies that address this issue. Outcome of elective endovascular abdominal aortic aneurysm repair in nonagenariansJournal of Vascular SurgeryVol. 54Issue 2PreviewCompared with open repair of abdominal aortic aneurysms (AAA), endovascular repair (EVAR) is associated with decreased perioperative morbidity and mortality in a standard patient population. This study sought to determine if the advantage of EVAR extends to patients aged ≥90 years. Full-Text PDF Open Archive

Mothers’ preferences and willingness to pay for HPV vaccines in Vinh Long Province, Vietnam

About 530,000 women develop cervical cancer worldwide and 275,000 die from the disease each year. Eighty percent of these deaths occur in developing countries. In Vietnam, cervical cancer has recently emerged as the most common type of cancer in women, and there are no national screening programs for cervical cancer. Since 2009, two different human papillomavirus (HPV) vaccines have been licensed for use in Vietnam, but access to these vaccines is generally limited to people who live in urban areas. Studies have shown that HPV vaccination may be cost-effective in cervical cancer prevention in Vietnam, depending on vaccination costs. Given that current HPV vaccines are expensive and public health funding for supporting a rapid introduction of the vaccine is limited, expanding and sustaining access to the HPV vaccine may require alternative financing mechanisms, such as fees-based immunization services.A conjoint analysis study was conducted with mothers of girls 9–17 years of age in Vinh Long Province in Vietnam to estimate the mothers’ demand for HPV vaccines for their daughters and to measure the tradeoffs between vaccine fees and vaccine uptake. The results suggest that the demand for HPV vaccines was high, increased with vaccine effectiveness and duration of effectiveness, and decreased with vaccine cost. Vaccine effectiveness was the most important vaccine attribute to these mothers, followed by duration of effectiveness. The predicted probability of respondents buying an HPV vaccine that was 70% effective for 10 years varied by the price, ranging from 30% when the vaccine price was $353 per course, to 68% when the vaccine cost $6 per course. As expected, demand and predicted purchase probability were higher among groups with higher socioeconomic status.