Willingness to pay for DLBCL treatment characteristics in Japan

Abstract Introduction:Treatment decision-making in relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) is increasingly complex, especially with the emergence of novel, high-cost therapies. Understanding how physicians weigh various clinical and non-clinical treatment attributes is essential for aligning healthcare decisions with both clinical value and economic sustainability. This study aims to quantify Japanese physicians' preferences in health outcomes and patient experience outcomes through eliciting trade-offs in a choice experiment for specific treatment characteristics in R/R DLBCL. Methods:We performed a Discrete Choice Experiment (DCE) with Japanese hematologists. Participants completed an online survey featuring a series of hypothetical treatment profiles that varied by key attributes. The DCE included two patient vignettes: Patient Q, a 70-year-old male with two prior treatment lines and ECOG performance status 1; and Patient R, a 58-year-old female with three prior treatment lines and ECOG performance status 2. Predefined attributes included: overall survival (OS) rates at 12 and 24 months, change in ECOG status at 6 months, risk of severe cytokine release syndrome (CRS), risk of severe neurological events, duration of hospitalization, time until treatment initiation, and total treatment cost. A Conditional Logit Model was used to calculate odds ratios (OR) for each attribute's influence on selecting the preferred treatment recommendation. ORs were translated into Willingness to pay (WTP) estimates for the health outcomes, changes in adverse event risks and waiting time / hospitalization duration. Results:A total of 231 Japanese hematologists and oncologists were recruited and met inclusion criteria for a study of six treatment decisions for each of the two patients. Depending on the patient vignette, several attributes significantly influenced treatment preferences. For both patient profiles, OS at 24 and 12 months, hospitalization duration, waiting time, and treatment cost were significant factors. For Patient Q, reduced CRS risk was significant, while for Patient R, ECOG improvement had a meaningful impact. WTP for each 1% improved probability of survival at 24 months was calculated at approximately ¥1.4 million (~USD 9,520) for Patient Q (p=0.000) and ¥1.8 million (~USD 12,240) for Patient R (p=0.000). WTP per 1% improvement in the rate of OS at 12 months was slightly lower at approximately ¥1.2 million (~USD 8,160) (p=0.000) and ¥1.3 million (~USD 8,840) (p=0.000) in Q and R, respectively. A one-week reduction in hospital stay corresponded to a WTP of ¥1.1–1.9 million (USD 7,480–12,920) (p=0.006 and p=0.000), while a one-week reduction in waiting time ranged from ¥600,000 to ¥1.5 million (USD 4,080–10,200) (p=0.048 and p=0.000). In addition, for Patient Q, a significant association was found between reduced risk of CRS and treatment preference, whereas for Patient R, improvement in ECOG performance status (from 2 to 0) had a significant impact on treatment choice. The trade-offs indicate in general that the responding physicians prioritized longer-term survival (24-month OS) more strongly for the younger, more severe patient, while preferences for 12- and 24-month OS were more balanced in the older, less severe case. Additionally, clinical improvement (ECOG) was more influential for the younger patient, whereas safety concerns—particularly reduced CRS risk—played a greater role in decisions for the older patient. Conclusions:Our findings suggest that Japanese hematologists and oncologists are cost-aware in their treatment decision-making. While improved OS remains the most valued outcome, reducing hospital length of stay is associated with substantial WTP, highlighting the importance of logistical and economic factors. Severity of prognosis shifted physician priorities to short-term survival, rapid access to care with more tolerance of adverse event risks. Future research should explore how these physician preferences align with patient perspectives.