Perspectives in the Value Assessment of Comprehensive Genomic Profiling: A Multi-Criteria Decision Analysis in NSCLC among Stakeholders.

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.