Table 2 Baseline-and what-if scenarios
From: Scenario drafting for early technology assessment of next generation sequencing in clinical oncology
Baseline scenario: “Within 5–10 years, NGS gene panels will become common practice for personalized treatment in oncology” | |||
|---|---|---|---|
Domain | What-if scenarios (likelihood ± SD) | Effect | Barrier/facilitator |
Social | 1. Patient perspective (66,5 ± 28,1; n = 13) Patients will demand lots of information on NGS-based panels, but will nevertheless be very interested in using them. | Higher uptake and more compliance | Pivotal facilitators |
2. Medical professional perspective (16,5 ± 8,8; n = 10 and 64,0 ± 8,9; n = 5) Medical professionals remain unconvinced of the clinical benefit that can be gained using NGS-panels and targeted therapy. | |||
Technical | 3. Organization (84,4 ± 18,5; n = 25) The time required for preparation, NGS and analysis of a biopsy will decrease so that patients will receive results within ten days after biopsy. | Higher uptake and less failures | |
4. FF versus FFPE (86,8 ± 13,1; n = 11 and 16,2 ± 9,4; n = 13) If reliable sequencing results can only be obtained by using FF tissue, the use of NGS-based panels will remain limited. | |||
Reimbursement | 5. Reimbursement (40,3 ± 24,1; n = 18) A ‘minimal requirements’ agreement between institutes developing NGS-based gene panels has resulted in national reimbursement policy of such panels. | Less uptake | Pivotal barriers |
Clinical utility and evidence generation | 6. Clinical Utility (50,4 ± 31,4; n = 25) Demonstrating clinical utility of NGS-panels will take at least a couple more years, adoption of this technology will only succeed once that point is reached. | No improved survival and slow release of new target/therapy combinations | |
7. Actionable targets (55,2 ± 23,7; n = 26) The number of mutations identified by NGS panels that can actually be targeted by therapy, remains limited. | |||
8. Off-label prescription (49,2 ± 31,1; n = 18) The medical community becomes more lenient towards off-label treatment. | |||
9. Revised evidence generation (65,5 ± 27,9; n = 29) Evidence from less time-consuming clinical studies than RCT III, will be considered valid to include new targets in NGS-based gene panels | |||
Market access | 10. Competition from a different field (45,0 ± 21,7; n = 25) Another type of technology enters the Dutch healthcare, decreasing the popularity of NGS-based gene panels. | Less uptake | |
11. Competition within the field (64,2 ± 21,9; n = 12) Another NGS-based panel outcompetes the NKI-panel, regardless of its additional features. | |||
12. Intellectual property (45,6 ± 28,7; n = 25) Competitors offering NGS-based panels will be reluctant to share new biological insights generated by NGS-panels with each other, thereby decelerating the improvement of clinical utility for patients. | |||