302 patients were randomised and available for analysis. The cost-effectiveness results suggested multi-parameter tumour testing was likely to be cost-effective. VOIA was able to prioritise tests for inclusion within the ongoing RCT despite the rapid turnaround time required for analysis. The results were highly dependent on modelling assumptions that were unavoidable early in the test development pipeline. Despite difficulties in communicating the unfamiliar concepts underpinning VOIA to the Trial Management Group, it was seen as an informative tool that influenced design decisions.