OBJECTIVES: To evaluate the cost-effectiveness of adding bevacizumab to single-agent chemotherapy for platinum-resistant recurrent ovarian cancer. METHODS: A decision-tree model was constructed to evaluate the cost-effectiveness of adding bevacizumab to standard treatment with single-agent chemotherapy (CT + B) as compared to treatment with single-agent chemotherapy alone. Transition probabilities were based on findings from AURELIA, an international randomized phase III clinical trial and the first to evaluate the survival benefits of adding bevacizumab to chemotherapy for women with platinum-resistant disease. Quality-adjusted life-years (QALYs), progression-free survival (PFS), and costs were modeled over a horizon of fifteen months. Assuming a U.S. public payer perspective, incremental cost-effectiveness ratios (ICERs) were evaluated as the incremental cost per QALY gained and the incremental cost per progression-free life-year saved. To evaluate the robustness of our results, we performed deterministic and probabilistic sensitivity analyses.  RESULTS: The ICERs associated with BEV + CT were $396,296 per QALY gained and $209,591 per progression-free life-year saved. Varying transition probabilities, costs, and utilities across the expected distribution of each parameter resulted in less than 1% of ICER estimates falling below the commonly accepted willingness to pay (WTP) threshold of $50,000/QALY gained; at a WTP threshold of $100,000/QALY gained, 10% of ICER estimates were cost-effective. One-way deterministic sensitivity analysis suggests that CT+B would become cost-effective at a WTP threshold of $50,000/QALY gained if the cost of treatment was reduced by 76%. CONCLUSIONS: Despite gains in QALYs and PFS, the addition of bevacizumab to single-agent chemotherapy for the treatment of platinum-resistant recurrent ovarian cancer would not be considered cost effective at a WTP threshold of $50,000/QALY gained or $100,000/QALY gained.  On a per-patient basis, individual expected benefits, risks, and costs associated with treatment should be taken into consideration when prescribing bevacizumab.