Abstract
BACKGROUND: Human papillomavirus (HPV) infection constitutes a substantial public health challenge in China. Despite proven vaccine efficacy, coverage remains critically low among high-risk sexually active college students. Out-of-pocket payment requirements contribute to the intention-behavior gap, while health literacy (HL) and vaccine hesitancy (VH) influence payment decisions. This study aims to directly quantify Chinese college students' willingness to pay (WTP) and price sensitivity, examining HL and VH as key determinants. METHODS: A convenience sample of 4,928 students at Guangdong Medical University in Dongguan, China was selected to complete a cross-sectional online survey (June 16-July 16, 2024) on the "Wenjuanxing" platform. We assessed socioeconomic status, HPV knowledge, HL, VH, and WTP through the survey and applied the van Westendorp price sensitivity meter (PSM) to quantify HPV vaccine price sensitivity. RESULTS: A total of 67.6% of the participants expressed a WTP for an out-of-pocket HPV vaccine, with 87.2% preferring nine-valent vaccines. Key factors identified included monthly expenses, medical insurance, HPV knowledge, HL, and the VH items' perceived necessity, importance, and vaccine safety. The van Westendorp PSM indicated that the market prices of the nine-valent vaccines exceeded the college students' acceptable price ranges. CONCLUSION: Examination of HL and VH provided a valuable framework for understanding the WTP for HPV vaccines. The van Westendorp PSM confirmed that the price sensitivity of the nine-valent HPV vaccine exceeded its affordability. Integrating vaccines into medical insurance, implementing targeted tiered subsidies (e.g., an optimal subsidy of 269.81 CNY, or at least 126.20 CNY), and conducting tailored education addressing HL/VH should be prioritized as potential solutions.