OBJECTIVES: To investigate, within the context of relapsed Ovarian Cancer's (OC) treatment, the associated costs to the Spanish National Healthcare System (NHS), using a patient segmentation based on platinum sensitivity: refractory/resistant (PR), partially Sensitive (PPS), fully sensitive (FPS); and the ones who are not suitable to receive further platinum treatments after previous relapse. Treatment ranks, based on cost-efficacy (CE) ratios, are then provided for all the above populations. METHODS: Survival data was collected from randomized controlled trials involving the main therapies approved on the relapsed OC setting. Acquisition and medical resource costs were sourced from the 2016 NHS price list. Health economics outcomes were the associated Incremental Cost Effectiveness Ratio (ICER) of every therapy compared to an appropiate reference by sensitivity. RESULTS:

• In PR patients, gemcitabine alone –followed by PLD- is the most cost-effective therapy, with an associated median cost of €47.1 per median survived month.
• In PPS patients, trabectedin plus DLP followed by a platinum based chemotherapy at relapse remains on top of the results, with an estimated ICER of €19,294 to €20,462 compared to DLP alone (with/out following platinum. Bevacizumab-based therapy rises to an ICER of €42,595; and the olaparib-based schema offers an estimated ICER of €24,841.
• Within the FPS stratum, carboplatin or paclitaxel plus PLD, are, by far, the cheapest treatment options, with estimated median costs per median survived month ranging from €84.1 to €166.7.

Trabectedin plus PLD remains a cost-effective option for those with allergy or intolerance to platinum compounds-, with an estimated ICER of €46,095 vs. the reference therapy (PLD plus carboplatin). CONCLUSIONS: To our knowledge; this is the first study showing a comprehensive review on the relapsed OC treatment associated costs from the NHS perspective in Spain. Results assert the value of trabectedin plus PLD as therapy of choice for both OC PPS and intolerant to platinum patients.