Real-World Treatment Patterns and Cost of Care in US Ovarian Cancer Patients Undergoing BRCA Testing.

Abstract

Background: Patients with ovarian cancer incur substantial economic burdens. However, little is known about the differences in metrics such as treatment patterns, healthcare resource utilization (HCRU), and costs between those with BRCA mutant (BRCAm) and BRCA wildtype (BRCAwt) tumors.

Objective: This study assessed demographic and clinical characteristics, treatment patterns, and HCRU and costs among patients diagnosed with ovarian cancer, stratified by BRCA testing status and result.

Methods: This retrospective study included patients with ovarian cancer between Jan. 1, 2017, and June 30, 2022, with electronic health record (EHR) and administrative claims data in Optum's Clinical EHR and claims databases. Data collected included baseline characteristics, lines of therapy (LOTs) (captured at 6, 12, and 24 months follow-up), HCRU (captured for 12-month baseline and follow-up periods), and costs (captured for 6-month baseline and 12-month follow-up periods). Patients were stratified by the presence or absence of a BRCA test and by BRCA testing results.

Results: A total of 13 981 patients were included in the sample; 23.3% had a BRCA test and 76.7% did not. Among those with a BRCA test, 62.0% were BRCAm and 35.8% were BRCAwt. Patients who did not receive BRCA testing were more likely to be non-Hispanic African American and to live in the South (all P < .001). Patients who received testing were more likely to progress to a subsequent LOT but also more likely to receive BRCA-targeted therapies. The median per-patient-per-month (PPPM) total costs were 62% higher in BRCA-tested patients than those without tests ( $6242vs$ 3845). Similarly, median PPPM ambulatory visits cost and pharmacy cost were 81% and 137% higher in those with BRCA tests than those without tests ( $2236vs$ 1232, and $793vs$ 335, respectively).

Conclusions: Approximately one-fourth of patients received BRCA testing. Disparities existed between those who received testing and those who did not. Patients who were tested had higher costs than those who were not; this difference was driven mostly by ambulatory visits and pharmacy costs, potentially due to increased clinical encounters and higher costs of targeted treatments.