Urologists’ stated preferences for high-cost surgical technology under different patient financial scenarios: a discrete choice experiment in China

Abstract Background High-cost surgical technologies can improve patient outcomes but may widen inequities when access depends on patients’ ability to pay. In technology-intensive surgery, affordability may be associated with access not only through patient uptake and hospital capacity, but also through clinicians’ stated recommendation preferences. This study examined whether urologists’ stated preferences for laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) differed between two hypothetical patient financial scenarios in China and whether these preferences varied by surgeon characteristics. Methods We conducted a national online discrete choice experiment among urologists practicing in robot-equipped public hospitals in China. Each respondent completed paired choice tasks under two patient financial scenarios: a financially well-resourced patient and a financially constrained patient. Attributes captured urinary continence recovery, total surgical charge, intraoperative surgeon fatigue, surgical-system availability, and additional incentives. Preference weights were estimated using mixed logit models. We derived scenario-specific attribute relative importance, generated illustrative scenario-based predictions, and explored preference heterogeneity through interactions with surgeon characteristics. Results The analysis included 211 urologists from 87 hospitals across 26 provinces. Stated preference patterns differed substantially between the two patient financial scenarios. In the financially well-resourced scenario, urinary continence recovery at 3 months had the highest estimated relative importance among the five attributes and prespecified level ranges examined, whereas total surgical charge was not statistically significant. In the financially constrained scenario, total surgical charge had the highest estimated relative importance within the same experimental framework. For the illustrative profiles combining differences in surgical charge, continence recovery, surgeon fatigue, and technology availability, the predicted probability of choosing the robot-assisted profile was 86.2% in the well-resourced scenario, whereas that of choosing the laparoscopic profile was 85.9% in the constrained scenario. Surgeons older than 35 years placed greater weight on reduced intraoperative fatigue, and sensitivity to surgical charge varied across regions. Conclusions Urologists’ stated preferences differed substantially between the two hypothetical patient financial scenarios. These findings suggest a potential affordability-sensitive pathway at the recommendation stage.