Adoption and Willingness to Pay for Emerging Dementia Therapies: Evidence from a Nationally Representative Survey
J. Felipe Montano-Campos, Julie Zissimopoulos, Mireille Jacobson, Bryan Tysinger, Xinran Lu, David A. Bennett, Geoffrey JoyceObjectives:
Decisions about emerging disease-modifying dementia therapies involve both treatment uptake and willingness to pay (WTP), reflecting the monetary valuation of treatment benefits. Existing studies often do not distinguish between these components of decision making, and evidence on WTP remains limited, particularly in nationally representative samples. We examine adoption and WTP as distinct margins to assess how treatment attributes and individual characteristics, including risk perceptions and knowledge of dementia, shape these decisions.
Methods:
We analyzed data from 1,539 US adults aged ≥50 y in the nationally representative Understanding America Study. In a structured stated-preference experiment, respondents evaluated 9 hypothetical dementia therapies varying in delivery mode (oral pill, monthly injection, monthly intravenous infusion), efficacy (delay in symptom progression of 1 vs 5 y), and mild side effects. Participants reported likelihood of adoption and, conditional on adoption, maximum WTP. Weighted logistic and ordered logit models estimated adoption and WTP, respectively.
Results:
Treatment attributes affected adoption and WTP in contrasting ways. Extending efficacy more than doubled adoption (odds ratio [OR] = 2.26; confidence interval [CI] 2.02–2.53) and increased WTP (OR = 1.30; 1.18–1.43). In contrast, mild side effects reduced adoption by 76% (OR = 0.24; 0.21–0.28) but were not associated with WTP (OR = 0.98; 0.89–1.09). Intravenous infusion reduced adoption relative to oral pills (OR = 0.75; 0.66–0.86) but increased WTP (OR = 1.24; 1.13–1.36). Higher perceived dementia risk was associated with greater adoption and WTP, while having someone close with dementia increased adoption but not WTP. Predicted WTP ranged from about $200 to $250 per month, with efficacy increasing WTP by roughly $25 to $30 across delivery modes.
Conclusions:
Adoption and WTP capture distinct components of treatment decision making. Distinguishing these margins provides policy-relevant insights into how treatment attributes and individual factors shape both uptake and monetary valuation of emerging dementia therapies.