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Updated: May 21, 2026

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Public acceptance and expectations for Lecanemab: Insights from a Smallest Worthwhile Difference study.

Aran Tajika1, Kenji Omae1,2, Ethan Sahker3

  • 1Department of Health Promotion and Behavioral Sciences, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.

Psychiatry and Clinical Neurosciences
|May 20, 2026
PubMed
Summary

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The public

Area of Science:

  • Neuroscience
  • Pharmacoeconomics
  • Public Health

Background:

  • Alzheimer's disease (AD) poses a significant public health challenge.
  • Lecanemab is a novel disease-modifying therapy for AD.
  • Understanding patient and public perception of treatment value is crucial for drug adoption.

Purpose of the Study:

  • To determine the smallest worthwhile difference (SWD) for lecanemab in Japan.
  • To assess public expectations of lecanemab's efficacy using a benefit-harm trade-off.
  • To explore psychological factors influencing treatment value perception.

Main Methods:

  • An online survey of 658 Japanese participants was conducted.
  • SWD was calculated as the minimum acceptable improvement in cognitive function maintenance.
Keywords:
Alzheimer's diseasecost–benefit analysislecanemabpatient preferencethe smallest worthwhile difference

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  • Preferences were evaluated considering lecanemab's risks, side effects, and costs.

    • Main Results:

    • The median SWD was a 15% increase in cognitive function maintenance, exceeding lecanemab's actual 8% efficacy.
    • Nearly half of respondents found the current efficacy worthwhile, with 17% reporting zero SWD due to AD fear.
    • No significant difference in SWD was observed between scenarios involving family members versus others.

    Conclusions:

    • Public expectations for lecanemab's efficacy in Japan surpass its demonstrated benefit.
    • Psychological factors like fear and hope significantly shape the perceived value of AD treatments.
    • Clinicians should manage patient expectations, acknowledging diverse preferences and emotional influences.