Epithelial ovarian cancer forms in the cells that line the ovaries and fallopian tubes. High-grade epithelial ovarian cancer grows more quickly than low-grade cancers, and treatment usually consists of surgery followed by chemotherapy. Patients who have responded to chemotherapy can undergo maintenance therapy, which is intended to postpone cancer progression or recurrence for as long as possible. One option for maintenance therapy is a drug called niraparib, but it can be associated with serious adverse events.

The homologous recombination repair pathway is a way of repairing damage to the DNA in our cells. A defect in the genes associated with this pathway leads to homologous recombination deficiency (HRD), which can lead to cancer. Certain treatments, including niraparib, are more likely to be effective in cancers associated with HRD. There are tests that can identify HRD, and HRD test results could be used to help people decide about whether to go ahead with niraparib maintenance therapy.

This health technology assessment looked at the clinical utility and cost-effectiveness of HRD testing to inform patient decisions about the use of niraparib maintenance therapy for patients with high-grade epithelial ovarian cancer. It also looked at the efficacy and safety of niraparib maintenance therapy in cancers with or without HRD. It explored the budget impact of publicly funding HRD testing, and the experiences, preferences, and values of people with ovarian cancer and their health care providers.