Order of Bullets in van Shaik, CGP Value

Original blog:   https://www.discoveriesinhealthpolicy.com/2024/09/journal-club-broad-tech-assessments-of.html 

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SIDEBAR: Why the Order?

 

1. Actionable Mutations Were Common, but Impact Was Unclear: I put this first because finding actionable mutations is the core promise of CGP. But if these findings don't consistently lead to better outcomes, then the whole premise of CGP becomes questionable. This felt like the most important point to address upfront.

2. Limited Diagnostic Impact: After actionable mutations, I wanted to highlight the diagnostic value of CGP. If it's not significantly improving or refining diagnoses, it calls into question whether CGP is doing enough to justify its use. So, I placed this right after the actionable mutations discussion.

3. Matched Treatments Had Inconsistent Results: This comes next because the idea behind CGP is to guide personalized treatment. If matched treatments are inconsistent across studies, it’s a major limitation. I felt that once we’ve talked about actionable mutations and diagnostic impact, discussing treatment outcomes naturally follows.

4. Clinical Utility Limited by Treatment Access: Even if CGP finds actionable mutations, if patients can’t access the treatments due to insurance or logistical issues, then the real-world utility is limited. This is a practical barrier that felt important to address early on, right after the more theoretical points about mutations and diagnostics.

5. No Randomized Controlled Trials (RCTs): I placed this high on the list because RCTs are considered the gold standard for proving efficacy. The absence of RCTs really weakens the conclusions about CGP’s clinical utility, so it seemed important to mention early.

6. Turnaround Time Variability: Turnaround time directly affects patient care, and if it’s inconsistent or too slow, CGP’s practical value in clinical settings diminishes. I thought this was an operational issue that needed to be addressed before moving on to more abstract concerns like study design.

7. Lack of Standardization in Outcomes: This is a big frustration because it makes it hard to compare results across studies. Without standardized outcomes, we can’t draw solid conclusions about CGP’s effectiveness, so it felt like a key limitation to highlight after the discussion on practical and clinical issues.

8. Difficulty in Assessing Long-Term Benefits: I wanted to emphasize that CGP’s potential long-term benefits, like hereditary findings, are often overlooked. This is a missed opportunity, and I thought it was important to mention before moving on to methodological and cost-related issues.

9. Observational Study Design Challenges: Since observational studies are the main source of data for CGP, their limitations have to be acknowledged. But I placed this a bit lower because it’s more of a methodological issue, which feels secondary to clinical outcomes and real-world utility.

10. Lack of Cost-Effectiveness Data: Cost-effectiveness is critical when deciding whether to implement a technology like CGP, but without strong data here, it’s hard to justify its use. I placed this lower because while it’s important, clinical and operational factors seemed more pressing.

11. Limited Empirical Evidence: There’s a lack of empirical evidence for some factors, like laboratory organization and scientific spillover. This is a significant gap, but I placed it lower because it’s not as immediately impactful as the clinical and financial concerns.

12. Need for Real-World Evidence and Comprehensive Assessments: Finally, I wanted to end with a forward-looking recommendation. The need for more real-world evidence and comprehensive assessments summarizes what’s missing and where future research should go. It felt like a natural conclusion after discussing all the limitations.

This order begins with the most pressing clinical findings and gradually moves toward methodological, operational, and future research concerns, creating a logical flow that prioritizes patient-centered utility before broader or systemic issues.