Determinants of Treatment Willingness and Willingness-to-Pay for Lecanemab in China

BACKGROUND: Lecanemab is the first disease-modifying therapy for Alzheimer disease (AD) approved in China. However, the factors affecting patient and caregiver willingness to adopt this novel treatment have not been assessed yet. OBJECTIVE: To investigate the factors influencing both treatment willingness and willingness-to-pay for lecanemab among Chinese AD patients and their caregivers. METHODS: We surveyed 195 AD patients and their caregivers using structured questionnaires assessing key factors influencing treatment willingness, including efficacy (W efficacy ), adverse effects (W adverse ), inconvenience (W inconvenience ), cost (W cost ), overall willingness to treat (W treat ), and amount willing to pay (W amount ). Additional variables included income, cognitive and functional assessments, caregiver burden (ZBI), health status (HS), education levels (patient/caregiver: edu, edu.c), psychiatric symptoms (PSY), and satisfaction with conventional treatments (effect). Network analysis mapped variable inter-relationships. RESULTS: W treat showed a strong direct association with W cost (0.99). W efficacy and W inconvenience indirectly influenced W treat through W cost (W efficacy -W inconvenience : 1.5, W inconvenience -W cost : 1.12, W cost -W treat : 0.99). Income (0.48) and effect (0.51) directly impacted W treat . Edu, edu.c, CDR, PSY, ZBI, and HS were indirectly correlated with W treat . W amount was directly associated with W treat (0.31), W cost (0.68), and W adverse (0.16). W efficacy and W inconvenience indirectly influenced W amount through W cost (W efficacy - W inconvenience : 1.5, W inconvenience -W cost : 1.12, W cost -W amount : 0.68). Network stability tests (CS >0.50) confirmed robustness. CONCLUSION: This study demonstrates that reducing payment barriers has a greater impact on real-world adoption of innovative therapies than clinical efficacy alone. Addressing financial constraints also enhances patients' willingness to pay. These findings provide evidence-based insights for developing patient-centered clinical decision pathways.