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Objectives:We sought to determine if use of a poly (ADP-ribose) polymerase (PARP) inhibitor is cost effective for maintenance treatment of platinum-sensitive recurrent ovarian cancer.Methods: A decision analysis model compared 4 maintenance strategies: 1) Observation 2) BRCA germline mutation testing and selective treatment of carriers (gBRCA only) 3) BRCA germline and tumor homologous recombination deficiency (HRD) testing andselective treatment of either BRCA carriers or those with tumor HRD (gBRCA and HRD only) 4) Treat all with niraparib to progression (treat all). Costs were estimated in 2016 US dollars. Incremental costeffectiveness ratios (ICERs) were in dollars per progression-free quality adjusted life-year (PF-QALY). One-way sensitivity analyses tested multiple assumptions.

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Careful consideration should be given to older patients prior to undergoing PCS. Survival outcomes were similar for patients with stage IV disease, although NACT was associated with decreased perioperative morbidity compared with PCS. Among women with stage III disease, PCS was associated with improved overall survival, but higher rates of perioperative morbidity and acute care.