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11/10/2025

The Estimated Long-Term Clinical Effects of BRCA Testing and Olaparib Treatment of Early Breast Cancer in the US Population: A Population Impact Model

Journal of Medical Economics MANUSCRIPT
Authors Adam Kasle, Qixin Li, Amy Tung, Xiaoqing Xu & David Veenstra

ABSTRACT
Aims: Olaparib is approved for the treatment of germline BRCA mutant (gBRCAm) high-risk early breast cancer (eBC) following treatment with neoadjuvant or adjuvant chemotherapy. The potential long-term outcomes of widespread germline BRCA testing and treatment with olaparib in the US have not been quantified.

Methods: We developed a decision-analytic model comparing a scenario with BRCA testing and olaparib treatment to a scenario with no testing and no treatment in an olaparib-eligible population. Olaparib-eligible population estimates were derived from
published literature; long-term treatment outcomes were based on a published costeffectiveness analysis. Breast cancer recurrences and life-years were projected over a lifetime. Scenario analyses were conducted to test different high-risk and testing
uptake assumptions.

Results: We estimated that 3,983 eBC patients in the US were eligible for olaparib in 2024. Compared with no testing and no treatment, testing and olaparib treatment resulted in 272 (22% reduction) and 68 (22% reduction) fewer metastatic breast cancer (mBC) and non-metastatic breast cancer (non-mBC) recurrences, respectively, over a lifetime. A 9% increase in life expectancy would be achieved from adopting testing and olaparib treatment. Over 10 years, we estimated 40,094 olaparib-eligible eBC patients. 2,496 mBC (22% reduction) and 618 non-mBC recurrences (22% reduction) would be prevented, and 78,672 life-years would be saved vs no testing. Scenario analyses with different high-risk definitions and testing assumptions demonstrated a maintained clinical benefit (range of 82 – 552 mBC and 20 – 137 non-mBC recurrences avoided over a lifetime).

Limitations: Results were based on long-term outcomes modeled on the results of the OlympiA clinical trial; these uncertainties were evaluated using sensitivity analyses. Conclusion: BRCA testing and subsequent treatment with olaparib results in fewer recurrences in eBC and a longer life expectancy vs no testing and no treatment, suggesting there is substantial clinical value in widespread BRCA testing for this population.

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