Preferences and willingness-to-pay for human papillomavirus vaccination among men who have sex with men in China: a discrete choice experiment

Background: The human papillomavirus (HPV) vaccine has been approved for use in Chinese males in 2025. We aimed to assess HPV vaccination preferences and willingness-to-pay (WTP) among men who have sex with men (MSM) in China using a discrete choice experiment (DCE). Methods: A cross-sectional survey was conducted from October 31 to November 30, 2023, among MSM aged 15–45 years in China, recruited offline and online. Data were collected using a self-administered online questionnaire. The DCE assessed preferences for seven HPV vaccination attributes: prevention of HPV-related cancers, prevention of genital warts, duration of vaccine protection, number of doses, vaccination cost, vaccination site, and service opening hours. Random parameters logit (RPL) and latent class analysis (LCA) models were applied to analyse preferences, estimate marginal WTP for each attribute, and predict uptake for various vaccination scenarios. Findings: The median age of the 7457 participants was 28 years (interquartile range: 25–35 years). In the RPL model, vaccine efficacy against genital warts was the most influential attribute (48.8 %, 95 % CI: 47.1–50.6 %), followed by vaccination cost (17.1 %, 15.7–18.4 %). LCA identified two subgroups: a “high-income/knowledge, low-sexual activity” group (49.2 %) and a “low-income/knowledge, high-sexual activity” group (50.8 %). Both groups prioritised vaccine efficacy, protection duration, and cost, and also favoured MSM-friendly clinics. The “high-income/knowledge, low-sexual activity” group valued genital wart prevention most (49.7 %) and preferred single-dose schedules and extended service hours, whereas the “low-income/knowledge, high-sexual activity” group prioritised cost (26.3 %). Under a potentially realistic scenario (9-valent HPV vaccination with feasible service-related attributes), both groups' WTP exceeded the current market price of the full-course vaccination (CNY 3993), with a higher predicted uptake in the former group (96.2 % vs. 50.8 %). Conclusion: This study underscores a high acceptance of HPV vaccination among Chinese MSM, emphasising the pivotal role of HPV knowledge, economic considerations, and service delivery preferences in shaping vaccination decisions.