BACKGROUND: Current chemotherapy in platinum-resistant ovarian cancer patients 
has demonstrated minimal to no improvements in survival. Despite the lack of 
benefit, significant resources are utilized with such therapies. Therefore, the 
objective in the current study was to assess the cost-effectiveness of salvage 
chemotherapy for patients with platinum-resistant epithelial ovarian cancer 
(EOC).
METHODS: A decision analysis model evaluated a hypothetical cohort of 4000 
platinum-resistant patients with recurrent EOC. Several chemotherapy strategies 
were analyzed: 1) best supportive care (BSC); 2) second-line 
chemotherapy-monotherapy; 3) second-line chemotherapy-combination therapy; 4) 
third-line chemotherapy after disease progression on second-line monotherapy; 
and 5) third-line chemotherapy after disease progression on second-line 
combination therapy. Sensitivity analyses were performed on all pertinent 
uncertainties.
RESULTS: Using costs alone, BSC was the only definitive cost-effective treatment 
for platinum-resistant recurrent ovarian cancer patients, and second-line 
monotherapy was a reasonable cost-effective strategy with an incremental 
cost-effectiveness ratio (ICER) of 64,104 dollars. The cost-effectiveness ranged 
from 4,065 dollars per month of overall survival (OS) for BSC to 12,927 dollars 
for third-line previous combination therapy. Compared with BSC, second-line 
monotherapy gained an additional 3 months of OS, with a cost-effectiveness of 
4,703 dollars per month of OS. Second-line combination therapy and third-line 
therapies exhibited unfavorable ICER.
CONCLUSIONS: The current decision analysis was intended to be thought-provoking 
and bring awareness to the high costs of subsequent chemotherapy with limited 
effectiveness in patients with recurrent platinum-resistant EOC. Although actual 
patients may receive multiple lines of chemotherapy, from the perspective of 
costs alone this model using a hypothetical cohort demonstrated that best 
supportive care was the only cost-effective strategy, with second-line 
monotherapy appearing to be a reasonable cost-effective strategy given current 
chemotherapeutic options.