| Summary: | <strong>Background:</strong> Genomic tests may improve the stratification of patients to receive new therapies in several disease areas. However, the use of expensive targeted therapies can impact on the costeffectiveness of these tests. This study presents an economic evaluation of genomic testing in chronic lymphocytic leukaemia (CLL) in the context of the UK National Health Service (NHS). <strong>Methods:</strong> Cost-effectiveness and cost-utility analyses (using life-years and quality-adjusted life-years - QALYs) were undertaken from an NHS and societal perspective. Five strategies were evaluated across several age groups using Markov modelling: three strategies that reflected varying current genetic testing practice and two configurations of genomic testing (including ibrutinib treatment). <strong>Results:</strong> Genomic testing strategies yielded the most life-years/QALYs per patient, but were not costeffective compared to a threshold of £30,000 per life-year/QALY gained. Cost-effectiveness acceptability curves indicated that there was some uncertainty surrounding this result. A genomic testing strategy becomes the most cost-effective option if a higher end-of-life cost-effectiveness threshold of £50,000 is applied, if a societal costing perspective is considered in 25 year old patients, or if the cost of ibrutinib treatment falls. <strong>Conclusion:</strong> Stratifying CLL patients to targeted treatment using genomic testing improves health outcomes, but will likely only represent a cost-effective use of limited NHS resources if a higher costeffectiveness threshold or societal costing perspective is applied, or if the price of ibrutinib treatment is reduced. This result may be broadly indicative of the likely cost-effectiveness of other genomic tests that inform the stratification of patients to high cost targeted therapies.
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