OBJECTIVES: Despite the considerable disease burden of ovarian cancer (OC), there were no cost studies in Central and Eastern Europe. This study aimed to describe treatment patterns, healthcare resource utilization and costs associated with OC in Hungary, Poland, Serbia and Slovakia. METHODS: Overall clinical practice for management of epithelial ovarian cancer was investigated through a three-round Delphi panel consisting of 15 clinical experts. Experts completed a survey based on patient records (N=1,542). The survey was developed based on clinical guidelines and the FIGO Annual Report. Means, ranges and outlier values were discussed with the experts during a telephone interview. Finally, consensus estimates were obtained in face-to-face workshops. Based on these results, overall cost of OC was estimated using a Markov model. RESULTS: The patients included in the chart review were followed from pre-surgical diagnosis and in each phase of treatment, i.e. primary surgical staging and surgery, chemotherapy and chemotherapy monitoring, follow-up and palliative care. Overall treatment patterns were similar but regimens in second and subsequent lines of chemotherapy varied across the countries. The 5-year overall cost per patient was €13,900-€17,200 in Hungary, €16,300-€18,300 in Poland, €8,900-€9,600 in Serbia and €12,500-€15,700 in Slovakia (presented in ranges due to  uncertainty around palliative care). Chemotherapy-associated costs accounted for 59-71% of the total, followed by primary surgical treatment (13-23%) and palliative care (4-15%). Contribution of drug costs to the overall costs varied among the countries (in Poland 29%, in Serbia 55% of total costs). CONCLUSIONS: Given the scarcity of OC cost studies worldwide, these findings may provide a useful source for clinicians and decision makers in understanding the economic implications of managing ovarian cancer in Central and Eastern Europe and the need for innovative therapies.