|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|
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.
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.
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
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.
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.