Presentation (CTI)

OBJECTIVES: Lecanemab remains unreimbursed by China's national insurance, creating barriers to access. This study quantifies the economic burden on Alzheimer's disease (AD) patients and evaluates the impact of two coping strategies—informal "vial sharing" and formal regional insurance ("Hui Min Bao")—on out-of-pocket (OOP) costs and treatment persistence.
METHODS: We conducted a retrospective social listening study on Xiaohongshu (Jan 2024-Nov 2025; N=6,908). A cost-minimization analysis was modeled for a representative 70kg patient (requiring 3.5 vials/dose) to calculate annual variances between standard purchasing and sharing strategies. Thematic analysis correlated payment models with caregiver-reported discontinuation intent.
RESULTS: Standard annual therapy cost is ~260,800 CNY ($36,200 USD). Analysis revealed three distinct patient segments:1. Full Self-Pay (Baseline): Patients purchasing full vials (4 vials/dose) incur 12.5% drug wastage per infusion. This group reported the highest frequency of "financial burnout" and discontinuation intent.2. Vial Sharing (Informal): ~15% of discussions involved patients pooling to split vials. Scenario analysis shows this strategy reduces annual costs to ~228,200 CNY, yielding a direct saving of ~32,600 CNY ($4,500).3. Regional Insurance (Formal): Patients in Tier-1 cities with "Hui Min Bao" coverage reported effective reimbursement rates up to 70%, reducing annual OOP to ~80,000 CNY ($11,100). This group demonstrated the highest treatment stability.
CONCLUSIONS: Economic burden is the primary driver of Lecanemab discontinuation in China. While informal "vial sharing" provides partial relief ($4,500 savings), it highlights inefficiencies in current weight-based packaging. Regional insurance schemes, offering substantial savings ($25,000 reduction), demonstrate the most profound impact on adherence. Expanding such coverage and optimizing vial sizes are critical for equitable access.