Objective <p>The PAOLA-1 trial demonstrated that olaparib plus bevacizumab (OB) significantly prolonged progression-free survival (PFS) and overall survival (OS) compared to bevacizumab monotherapy (BM) as first-line maintenance therapy for patients with advanced ovarian cancer (AOC) who had homologous recombination deficiency (HRD)-positive status at high risk of disease progression (HRisk-HRD⁺), including both the <i>breast cancer susceptibility gene</i> mutated (<i>BRCA</i>m) subgroup and the <i>BRCA</i> wild-type (<i>BRCA</i>wt) subgroup. This study aimed to assess its cost-effectiveness from the perspective of the Chinese healthcare system.</p> Methods <p>A state-transition Markov model over a 20-year lifetime horizon was developed to evaluate the cost-effectiveness of OB compared to BM. The willingness-to-pay (WTP) thresholds were set at 1 to 3 times the gross domestic product per capita of China in 2024 ($13444.68 to $40334.05/QALY). The primary outcomes included total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Subgroup analysis, sensitivity analysis and scenario analyses were performed to validate the robustness of the study.</p> Results <p>Compared with BM, the ICERs of OB were $10806.70/QALY, $10478.80/QALY and $25114.44/QALY in the HRisk-HRD⁺ population, <i>BRCA</i>m subgroup and <i>BRCA</i>wt subgroup, respectively. OB demonstrated potential cost-effectiveness for patients with HRisk-HRD⁺ AOC, particularly those with a <i>BRCA</i> mutation. One-way sensitivity analysis indicated that the discount rate and the price of olaparib were the primary factors influencing the ICER. The results of the probabilistic sensitivity analysis and scenario analysis were generally consistent with those of the base-case analysis.</p> Conclusions <p>Compared to BM, OB demonstrated superior cost-effectiveness as first-line maintenance therapy for patients with HRisk-HRD⁺ AOC, particularly those with a <i>BRCA</i> mutation in China.</p>