Table 3.

Additional verbatim quotes from the dimensions of the economic utility and cost considerations domain

Recognition of potential downstream benefits and the concerns of sustainability	We’re obviously very interested in hospitalizations and preventing re-hospitalizations and expense of adverse events. If these tests do show robust predictive value, then we would be interested in using them. Again, this is probably going to be on a case-by-case basis. Medical Director #5 - Medical group with insurance policy	The cost savings would be not having to re-stent the patient that didn’t have the enzyme. I think that there’s a lot of application for it. I think that it’s just a little bit premature I guess because of the way the design is currently in the marketplace for pharmaceuticals. Pharmacy Director #7 - Regional Health Plan	Would we focus it on where we had potential risks either in preventable admissions or hospital readmissions and have offsets? Yes. I think when it trickles down through all that triage, to what’s good for society and good for the patient to get an earlier experience, I’m gonna suggest probably funding and resources run out before we get to that level of compassion and empathy. Pharmacy Director #8 - Large National Plan	You’re committing yourself to doing a fairly substantial expense on a large number of patients. The problem you’re going to run into there is, again, a big upfront cost for unknown value down the road. Medical Director #4 - Drug Benefit Collaborative
Stratifying beneficiaries for coverage	I’d even consider in high-risk populations, the possibility you have here of the preemptive testing. If there’s evidence that every childhood asthmatic should get preemptive testing or evidence that every patient post-myocardial infarction should get preemptive testing, I’m willing to consider that also. Pharmacy Director #9 - Integrated Health System Plan		I think that if you have a patient that’s 60 years old and they’re relatively healthy, you may have already done this; but you may decide that at that age 60, it’s time that he or she has this information in his file, so the $500 gets spent. I think that’s going to be really up to the physician on how they view the patient. But I don’t think we are going to go out and promote a multi-gene testing for everybody over 65 or everybody over 60 just because the consortium or the guidelines say that is the right patient for these. Pharmacy Director #5 - Regional Health Plan
Number needed to test	Maybe you can come up with something like that for this type of testing and specific diseases. If you could come up with NNT. A lot of docs really hang their hat on that stuff. It might also be indicative to whether a payer pays for it or not to. Medical Director #5 - Medical Group with Insurance Policy		I guess my question is if you test 100 people how many do you have to test I guess, like how many (tests) to prevent that one adverse event or to prevent that one hospitalization? Again the assumption is that we are being told that if you test everybody you are going to reap benefits from everybody you test. Pharmacy Director #7 - Large Regional Health Plan