OBJECTIVES : Appropriate use of comprehensive genomic profiling (CGP) in oncology has been shown to impact treatment decisions and improve patient outcomes. However, due to its complexity and impact uncertainties, value assessment and reimbursement decisions can be challenging. Leveraging a broad value perspective and innovative contracting may provide a framework for improved decision-making about the reimbursement and use of CGP. Our objective was to identify the elements of value and potential for innovative contracting for CGP in cancer.

METHODS : Targeted literature searches were performed to identify value frameworks applicable to CGP. Potential types of innovative contracting for CGP were identified using the University of Washington Performance-based Risk-Sharing Database, supplemented by targeted literature searches. Expert input from academicians, manufacturers, and clinicians was used to refine the elements of value applicable to CGP and identify potential options for innovative contracting and contracting metrics. Finally, we undertook qualitative interviews with a convenience sample of 2 health insurers, 2 employer representatives, and 4 providers with knowledge and/or experience with CGP to characterize stakeholder perspectives about the value of CGP and opportunities for innovative contracting.

RESULTS : Health outcomes, net costs, and reduction in uncertainty were considered the most important elements of value of CGP for stakeholders. Specifically, the ability of CGP to support clinical decisions with actionable information was of value to providers. Innovative contracting was considered applicable to CGP, but challenging due to difficulties in choosing outcome metrics and administrative burden. Innovative contracting options considered most feasible were outcomes-based contracts linked to testing outcomes or process metrics, value-added contracts, and complex pricing contracts.

CONCLUSIONS : Important elements of value for CGP are health outcomes, especially through clinical decision support, net costs, and reduction in uncertainty. Innovative contracts that address these elements can potentially be used in CGP, but future work is needed to mitigate challenges.