And a few more for comparison.
Again I acknowledge that this isn’t the same as being inside Plex. 
This is all speedtest1, new files each time, varying the page_size and cache_size only.
# Variants of this command:
rm testfile.db ; ./speedtest1 --size 200 --journal WAL --pagesize 1024 --cachesize 2000 testfile.db | grep TOTAL
1024, 2000 = 2048000
TOTAL....................................................... 55.506s
1024, 4000 = 4096000
TOTAL....................................................... 37.873s
1024, 8000 = 8192000
TOTAL....................................................... 28.760s
1024, 16000 = 16384000
TOTAL....................................................... 25.225s
1024, 32000 = 32768000
TOTAL....................................................... 23.631s
4096, 500 = 2048000
TOTAL....................................................... 40.840s
4096, 1000 = 4096000
TOTAL....................................................... 26.579s
4096, 2000 = 8192000
TOTAL....................................................... 19.361s
4096, 4000 = 16384000
TOTAL....................................................... 16.785s
4096, 8000 = 32768000
TOTAL....................................................... 16.000s
8192, 250 = 2048000
TOTAL....................................................... 43.045s
8192, 500 = 4096000
TOTAL....................................................... 27.014s
8192, 1000 = 8192000
TOTAL....................................................... 18.549s
8192, 2000 = 16384000
TOTAL....................................................... 15.743s
8192, 4000 = 32768000
TOTAL....................................................... 14.958s
16384, 125 = 2048000
TOTAL....................................................... 50.152s
16384, 250 = 4096000
TOTAL....................................................... 30.167s
16384, 500 = 8192000
TOTAL....................................................... 19.542s
16384, 1000 = 16384000
TOTAL....................................................... 15.579s
16384, 2000 = 32768000
TOTAL....................................................... 14.589s
32768, 62 = 2031616
TOTAL....................................................... 68.670s
32768, 125 = 4096000
TOTAL....................................................... 39.802s
32768, 250 = 8192000
TOTAL....................................................... 22.690s
32768, 500 = 16384000
TOTAL....................................................... 16.824s
32768, 1000 = 32768000
TOTAL....................................................... 15.124s
I observe the same catastrophe you mentioned. Very large page_size values, with constrained total cache_size, behave very poorly indeed.
But at page_size of 4096, while maintaining the same total cache_size, increasing page_size is a big win.
… in synthetic tests.
I see your last comment. Please know how much I appreciate you sharing the information you’ve shared.