What are the preferences of health care professionals in Germany regarding fully liquid, ready-to-use hexavalent pediatric vaccine versus hexavalent pediatric vaccine that needs reconstitution?

Figures & data

Table 1 Attribute list with associated descriptions and the levels that were used in the survey

Attribute	Description	Level
Type of device	The hexavalent vaccine injection device can either be a PFS or an injection device which requires reconstitution. This feature will relate to whether you prefer one device or the other. The reconstitution injection device includes two consumables (syringe and vial), and the ready-to-use device includes one consumable, which is a PFS. Later in the survey, you will be presented with hypothetical devices which will either be a PFS or a reconstitution device.	• An injection device set that includes a ready-to-use PFS, with one consumable used • An injection device set that includes two consumables and requires reconstitution
Experience of using this hexavalent vaccine device available on the German market	This feature relates to the experience that HCPs would have with a hexavalent vaccine injection device that is available in the German market. For this feature, please imagine that there is a device which has been available on the German market for a number of years and you have experience of using this vaccine device. Later on in the survey, we will present you with hypothetical hexavalent injection devices and ask you to imagine the number of years you have had experience of using them.	• HCPs have had less than 1 year of experience • HCPs have had between 1 and 3 years of experience • HCPs have had more than 3 years of experience
Preparation time	Different hexavalent injection devices can vary in the number of steps and minutes it takes to prepare them before administering the vaccination with the device. For example, with a reconstitution device you will take the vial from the fridge, remove the cap from the vial, inject the contents of the vial into the syringe, mix and shake, aspire the content vial into the syringe, and discard the vial. With a PFS, once removed from the fridge, you shake the device well, remove the cap, and the device is ready to use. Later on in the survey, we will ask you to consider hypothetical hexavalent injection devices which will vary in the time taken to prepare them.	• 30 seconds • 1 minute • 2 minutes
Probability of handling errors related to the number of preparation steps (eg, contamination, missing vials, and needlestick injury)	This feature relates to the number of steps involved in preparing different hexavalent vaccine injection devices for administration. Each additional step increases the probability of manipulation errors such as contamination or needlestick injuries to the HCP, which would mean that device and that vaccine, would have to be discarded. Later on in the survey, please imagine that you have been asked to use a hypothetical injection device, which may vary in the number of preparation steps and therefore the probability of handling errors.	• An error will occur in 1 in 100 vaccinations • An error will occur in 1 in 200 vaccinations • An error will occur in 1 in 500 vaccinations
Probability of dosage errors (eg, liquid left in a vial, wastage)	Sometimes, it is possible that when using the injection device to administer the hexavalent vaccine, the entire contents of the vaccine is not used/drawn or the lyophilized vaccine component may have been missed when preparing the injection device. If this occurs, this could lead to the infant not receiving the full hexavalent vaccine dosage. Later on in the survey, the hypothetical injection devices that you are presented with may vary in terms of the probability of such errors of dosage occurring.	• An error will occur in 1 in 100 vaccinations • An error will occur in 1 in 500 vaccinations • An error will occur in 1 in 1,000 vaccinations

Abbreviations: HCP, health care professionals; PFS, prefilled syringe.

Table 2 Sociodemographic and current clinical practice profile of the sample by profession

	Total (n=300)	Physician (n=150)	Nurse (n=150)
Male, n (%)	143 (47.7)	103 (68.7)	40 (26.7)
Median age range	45–50 years old	51–54 years old	35–40 years old
Number of hexavalent vaccines prepared/administered per month
	Between 1 and 250 doses	Between 10 and 250 doses	Between 1 and 160 doses
Current role, n (%)
Only prepare	81 (27.0)	2 (1.3)	79 (52.7)
Only administer	117 (39.0)	103 (68.7)	14 (9.3)
Prepare and administer	102 (34.0)	45 (30.0)	57 (38.0)
Vaccine used most frequently, n (%)
Hexyon	98 (32.7)	40 (26.7)	58 (38.7)
Infanrix-hexa	202 (67.3)	110 (73.3)	92 (61.3)
Vaccine device used most often, n (%)
Non-fully-liquid (requires reconstitution)	135 (45.0)	100 (66.7)	35 (23.3)
Fully liquid (ready-to-use)	165 (55.0)	50 (33.3)	115 (76.7)
Number of years a hexavalent vaccine has been available is important to HCP, n (%)
Yes	124 (41.3)	72 (48.0)	52 (34.7)
No	176 (58.7)	78 (52.0)	98 (65.3)
Number of years a vaccine has been available influences HCP’s choice of hexavalent vaccine, n (%)
Yes	123 (41.0)	71 (47.3)	52 (34.7)
No	177 (59.0)	79 (52.7)	98 (65.3)
Number of years HCP has with using their current hexavalent vaccine, n (%)
<1 years	38 (12.7)	22 (14.7)	16 (10.7)
1–3 years	86 (28.7)	22 (14.7)	64 (42.7)
>3 years	176 (58.7)	106 (70.7)	70 (46.7)
Estimate number of seconds/minutes to prepare vaccine (currently), n (%)
30 seconds	96 (32.0)	48 (32.0)	48 (32.0)
1 minute	161 (53.7)	76 (50.7)	85 (56.7)
2 minutes	43 (14.3)	26 (17.3)	17 (11.3)
How often a handling error with a hexavalent vaccination has occurred, n (%)
Never	116 (38.7)	60 (40.0)	56 (37.3)
One in 1,000 vaccinations	95 (31.7)	54 (36.0)	41 (27.3)
One in 500 vaccinations	39 (13.0)	21 (14.0)	18 (12.0)
One in 200 vaccinations	36 (12.0)	13 (8.7)	23 (15.3)
One in 100 vaccinations	14 (4.7)	2 (1.3)	12 (8.0)
How often a dosage error with a hexavalent vaccination has occurred, n (%)
Never	168 (56.0)	94 (62.7)	74 (49.3)
One in 1,000 vaccinations	56 (18.7)	26 (17.3)	30 (20.0)
One in 500 vaccinations	31 (10.3)	17 (11.3)	14 (9.3)
One in 200 vaccinations	29 (9.7)	11 (7.3)	18 (12.0)
One in 100 vaccinations	16 (5.3)	2 (1.3)	14 (9.3)

Abbreviation: HCP, health care professional.

Table 3 Results of the conditional logit model, for preferences of attributes

Attribute	Levela	Total (n=300)		Physician (n=150)		Nurse/Clinical assistant (n=150)
		OR (SE)	95% CI	OR (SE)	95% CI	OR (SE)	95% CI
Type of device	Fully liquid	1.591^002A (0.036)	1.483, 1.707	1.450* (0.051)	1.312, 1.602	1.755* (0.051)	1.588, 1.939
	Requires reconstitutionb	–	–	–	–	–	–
Years of experience using hexavalent vaccine	>3 years	1.845* (0.048)	1.662, 2.048	2.257* (0.077)	1.940, 2.626	1.513* (0.075)	1.307, 1.751
	1–3 years*	1.675* (0.053)	1.525, 1.840	1.848* (0.070)	1.612, 2.119	1.538* (0.067)	1.350, 1.753
	<1 yearb	–	–	–	–	–	–
Preparation time	30 seconds*	2.331* (0.056)	2.090, 2.599	2.449* (0.081)	2.089, 2.870	2.241* (0.077)	1.928, 2.606
	1 minute*	1.698* (0.046)	1.552, 1.857	1.832* (0.065)	1.612, 2.082	1.581* (0.065)	1.392, 1.795
	2 minutesb	–	–	–	–	–	–
Probability of handling errors	One in 500*	2.100* (0.052)	1.895, 2.327	2.268* (0.074)	1.960, 2.624	1.951* (0.074)	1.687, 2.256
	One in 200*	1.482* (0.046)	1.353, 1.623	1.541* (0.067)	1.351, 1.759	1.427* (0.065)	1.257, 1.621
	One in 100b	–	–	–	–	–	–
Probability of dosage error	One in 1,000*	3.727* (0.054)	3.350, 4.145	3.615* (0.078)	3.101, 4.215	3.954* (0.077)	3.400, 4.598
	One in 500*	2.489* (0.046)	2.273, 2.725	2.572* (0.067)	2.256, 2.933	2.439* (0.065)	2.149, 2.768
	One in 100b	–	–	–	–	–	–

Notes:

a The reconstitution level or the worse level of each attribute is used as the reference case;

b reference cases;

* significant at P<0.001.

Abbreviations: OR, odds ratio; SE, standard error; CI, confidence interval.