Health Gains Associated With Homologous Recombination Deficiency Testing for Ovarian Cancer in South Korea: A Model-Based Analysis
Author(s)
Jihyun Kang, R.N., B.S.1, Hye-Young Kang, R.Ph., Ph.D.2.
1Graduate Program of Industrial Pharmaceutical Science, Yonsei Institute of Pharmaceutical Science, Yonsei University, Incheon, Korea, Republic of, 2College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Korea, Republic of.
1Graduate Program of Industrial Pharmaceutical Science, Yonsei Institute of Pharmaceutical Science, Yonsei University, Incheon, Korea, Republic of, 2College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Korea, Republic of.
OBJECTIVES: Ovarian cancer remains one of the most life-threatening gynecologic cancers, with a high likelihood of recurrence. To help prevent relapse, maintenance therapies have become essential—particularly poly (ADP-ribose) polymerase (PARP) inhibitors, which are now reimbursed by the Korean National Health Insurance (NHI). However, access to homologous recombination deficiency (HRD) testing, a prerequisite for prescribing certain PARP inhibitors, is not currently covered by the Korean NHI. This study aimed to assess the potential clinical benefit of HRD testing in patients with ovarian cancer, to inform future decision-making.
METHODS: A decision-analytic model combining a decision tree with a partitioned survival analysis (PartSA) framework was developed to estimate health outcomes in patients with advanced ovarian cancer who are eligible for maintenance PARP inhibitor therapy. Two strategies were compared: (1) Breast Cancer Susceptibility Gene (BRCA) testing alone, and (2) BRCA testing followed by HRD testing. Key survival outcomes, including progression-free survival (PFS) and overall survival (OS), were derived from published clinical trials. Model outcomes included life-years (LYs), quality-adjusted life-years (QALYs), progression-free life-years gain(PF-LYG), and quality-adjusted progression-free survival (QA-PFS). A 5-year time horizon and a 4.5% annual discount rate were applied.
RESULTS: The HRD testing strategy yielded 3.343 LYs and 2.340 QALYs, compared to 3.310 LYs and 2.244 QALYs with BRCA testing alone—resulting in incremental gains of 0.034 LYs and 0.096 QALYs. For PFS-based outcomes, HRD testing achieved 2.026 PF-LYG and 1.681 QA-PFS, versus 1.786 and 1.482 with BRCA-only testing—reflecting gains of 0.239 and 0.199, respectively, and indicating an extended progression-free period with improved quality of life.
CONCLUSIONS: Although overall survival improvement was limited, the gains in progression-free survival and quality-adjusted progression-free survival suggest that HRD testing can help maintain patients’ quality of life by prolonging the time without progression. These findings support its integration into personalized diagnostic strategies in settings where PARP inhibitors are reimbursed.
METHODS: A decision-analytic model combining a decision tree with a partitioned survival analysis (PartSA) framework was developed to estimate health outcomes in patients with advanced ovarian cancer who are eligible for maintenance PARP inhibitor therapy. Two strategies were compared: (1) Breast Cancer Susceptibility Gene (BRCA) testing alone, and (2) BRCA testing followed by HRD testing. Key survival outcomes, including progression-free survival (PFS) and overall survival (OS), were derived from published clinical trials. Model outcomes included life-years (LYs), quality-adjusted life-years (QALYs), progression-free life-years gain(PF-LYG), and quality-adjusted progression-free survival (QA-PFS). A 5-year time horizon and a 4.5% annual discount rate were applied.
RESULTS: The HRD testing strategy yielded 3.343 LYs and 2.340 QALYs, compared to 3.310 LYs and 2.244 QALYs with BRCA testing alone—resulting in incremental gains of 0.034 LYs and 0.096 QALYs. For PFS-based outcomes, HRD testing achieved 2.026 PF-LYG and 1.681 QA-PFS, versus 1.786 and 1.482 with BRCA-only testing—reflecting gains of 0.239 and 0.199, respectively, and indicating an extended progression-free period with improved quality of life.
CONCLUSIONS: Although overall survival improvement was limited, the gains in progression-free survival and quality-adjusted progression-free survival suggest that HRD testing can help maintain patients’ quality of life by prolonging the time without progression. These findings support its integration into personalized diagnostic strategies in settings where PARP inhibitors are reimbursed.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO127
Topic
Clinical Outcomes, Health Technology Assessment
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Oncology