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Published on: September 8, 2023
Perspectives in the Value Assessment of Comprehensive Genomic Profiling: A Multi-Criteria Decision Analysis in NSCLC
L F van Schaik1, A Fernández Coves2, S E Grimm2
1Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Objectives:
Comprehensive genomic profiling (CGP) can identify more actionable variants than targeted profiling (TP) in advanced non-small cell lung cancer (NSCLC), yet its clinical benefit and cost-effectiveness remain uncertain. Additional criteria may also influence reimbursement decisions. We conducted a multi-criteria decision analysis (MCDA) to explore how Dutch stakeholders value CGP compared to TP.
Methods:
Seven decision criteria were evaluated: clinical benefit, cost-effectiveness, feasibility, patient/physician test journey, wider implications of diagnostic results, organization of laboratories, and scientific spillover. Evidence-informed performance scores were assigned to clinical benefit and cost-effectiveness, the latter under two scenarios: a lower score for CGP and an equal score for both strategies. The remaining five criteria were scored by stakeholders via an online survey. Relative criterion weights were elicited through point allocation. Aggregated scores were calculated using an additive model.
Results:
Thirty-eight respondents (39% pulmonologists, 34% molecular biologists, 24% pathologists, 8% patient representatives) completed the survey between December 2024 and February 2025. CGP outperformed TP on wider implications of diagnostic results, organization of laboratories, and scientific spillover, while TP scored higher for feasibility. Clinical benefit (mean weight 0.35±0.20) and cost-effectiveness (0.16±0.19) were the most important criteria. Under the unfavourable CGP cost-effectiveness scenario, TP scored slightly higher (overlapping confidence intervals), whereas CGP scored higher when cost-effectiveness was scored equally.
Conclusions:
The preferred strategy shifted with the assumed cost-effectiveness score: TP scored slightly higher under the unfavourable CGP scenario, CGP higher when scored equally. As this assumption drives the ranking, neither strategy is clearly superior. CGP's strong performance on several of the five stakeholder-scored criteria indicates value beyond on-label treatment selection. Incorporating broader criteria using MCDA provides a comprehensive and transparent framework for reimbursement deliberations combining different perspectives in genomic profiling for advanced NSCLC.
