Cost and Clinical Implications of Utilizing Homologous Recombination Deficiency Status to Guide First-Line Maintenance Therapy Selection in Advanced Ovarian Cancer

Questions remain about the cost of homologous recombination de­ficiency (HRD) testing to guide the prescribing of poly (ADP-ribose) polymerase (PARP) inhibitors as first-line maintenance for advanced ovarian cancer (AOC). This model evaluates the cost of an HRD biomarker-guided (BMG) approach (olaparib for BRCA-mutated; olaparib and bevacizumab for HRD-positive BRCA wildtype; bevacizumab for HRD-negative) vs a non-BMG approach (niraparib for all patients) for 100 patients with newly diagnosed AOC. The model uses a Mar­kov structure with a US payer perspective and assumes comparisons between therapies based on extrapolated clinical trial results, real-world evidence, and published costs. Despite the upfront cost of HRD testing, a BMG approach is pro­jected to reduce total cost of care by $10 521 642 over 5 years ($51 633 928 vs $62 144 570) and increase progression-free survival in the AOC population (1699 vs 1523 months). This produces $26 in savings for every dollar spent on testing. These data suggest using a BMG approach based on HRD test results to pre­scribe first-line AOC maintenance therapy may reduce overall cost of care and improve clinical and economic outcomes.