Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Cost-utility of BRCA and homologous recombination deficiency testing-guided treatments in ovarian cancer (146282)

Karitika Kashyap 1 , Srinivas Teppala 1 2 , Connie I Diakos 3 , Christine Y Lu 1 2
  1. School of Pharmacy, Faculty of Medicine and Health , The University of Sydney, Camperdown, Sydney, 2050 , NSW, Australia
  2. Kolling Institute, Faculty of Medicine and Health , The University of Sydney and The Northern Sydney Local Health District , St Leonards, Sydney, 2065, NSW, Australia
  3. Department of Medical Oncology , Royal North Shore Hospital , St. Leonards, Sydney, 2065, NSW, Australia

Aims: Genetic testing for BRCA mutations and homologous recombination deficiency (HRD) is integral in the management of high-grade ovarian cancer (HGOC) and informs treatment with poly (ADP-ribose) polymerase inhibitors (PARPis). Although PARPis significantly prolong progression-free survival (PFS), they are expensive, and whether they represent value for money remains unclear. This study presents the first economic evaluation to simultaneously assess the cost-utility of BRCA and HRD testing-guided treatments in ovarian cancer (OC). 

Methods: A semi-Markov model, informed by PFS and overall survival (OS) data from landmark clinical trials, was developed to evaluate two treatment scenarios for PARPi maintenance, with or without bevacizumab, in newly diagnosed HGOC after initial platinum chemotherapy. Scenario 1 estimated the cost-utility of PARPi monotherapy in BRCA-mutated HGOC. Scenario 2 examined the cost-utility of PARPi plus bevacizumab in HRD-positive HGOC. Patients transitioned between three health states: progression-free, progressed disease, and death (terminal state). Analyses were performed from an Australian healthcare system perspective; costs and quality-adjusted life years (QALYs) were estimated in monthly cycles over a lifetime horizon. One-way and probabilistic sensitivity analyses assessed uncertainty. 

Results: In BRCA1/2-mutated HGOC, olaparib maintenance post-chemotherapy was associated with an incremental cost of AU$26,343, a gain of 0.887 QALYs, resulting in an incremental cost-effectiveness ratio (ICER) of AU$29,703/QALY, and a 99% probability of being cost-effective at a willingness-to-pay threshold of AU$75,000/QALY. Meanwhile, olaparib plus bevacizumab maintenance in HRD-positive HGOC had higher incremental costs of AU$63,902, a QALY gain of only 0.327 and a resulting ICER of AU$195,316/QALY, indicating that the strategy was unlikely to be cost-effective. 

Conclusion: Genetic testing-guided olaparib maintenance after first-line platinum chemotherapy is likely to be cost-effective in patients with BRCA1/2-mutated HGOC. However, expanding testing to identify HRD mutations beyond BRCA1/2, followed by olaparib plus bevacizumab maintenance, is unlikely to be cost-effective under current Australian willingness-to-pay thresholds.