WHERE DO WE GO WITH WHOLE GENOME SEQUENCING IN ONCOLOGY? USING SCENARIO DRAFTING TO EXPLORE FUTURE DEVELOPMENTS

OBJECTIVES: Whole genome sequencing (WGS) is a promising but complex technology. WGS is not yet widely used as a clinical diagnostic in oncology due to several barriers, such as the required infrastructure and expertise, costs, and unknown clinical utility. This study aimed to investigate possible future developments facilitating or impeding the implementation and adoption of WGS in this context. Exploring WGS development scenarios can inform strategic choices by assessing their likelihood of occurring and their consequences for the healthcare system. METHODS: Scenario drafting is an iterative process. First, a literature review was performed on potential barriers and facilitators related to the implementation of disruptive health technologies and WGS in particular. Second, the knowledge and opinions of national and international experts were used to prioritize these barriers and facilitators. Third, several of barriers or facilitators were combined into a set of coherent scenarios that each describe a possible future development. Fourth, these scenarios were validated internally and checked for plausibility by our research consortium. Fifth, expert opinion was elicited from a group of international experts. They were asked with which likelihood each scenario would take place in the next five years. Sixth, the data were pooled to create probabilities distributions for the likelihood of each scenario. RESULTS: Five domains were identified that are relevant to the implementation of WGS: technical, market access, clinical utility, and evidence generation, social, and reimbursement. Preliminary results indicate that experts consider the price of WGS, its clinical utility, and the turnaround time of WGS important aspects that can affect the implementation of WGS. Scenarios that describe a future development related to these aspects were created and probabilities were elicited. CONCLUSION: Possible future developments have been assessed on likelihood of occurring and these assessments can be used in strategic decision-making regarding the the implementation of WGS.