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To examine the cost of care during the first year after a diagnosis of ovarian cancer, estimate the sources of cost, and explore the out-of-pocket costs.We performed a retrospective cohort study of women with ovarian cancer diagnosed from 2009 to 2012 who underwent both surgery and adjuvant chemotherapy using the Truven Health MarketScan database. This database is comprised of patients covered by commercial insurance sponsored by more than 100 employers in the United States. Medical expenditures, including physician reimbursement, for a 12-month period beginning on the date of surgery were estimated. All payments were examined, including out-of-pocket costs for patients. Payments were divided into expenditures for inpatient care, outpatient care (including chemotherapy), and outpatient drug costs. The 12-month treatment period was divided into three phases: surgery to 30 days (operative period), 1–6 months (adjuvant therapy), and 6–12 months after surgery. The primary outcome was the overall cost of care within the first year of diagnosis of ovarian cancer; secondary outcomes included assessment of factors associated with cost.A total of 26,548 women with ovarian cancer who underwent surgery were identified. After exclusion of patients with incomplete insurance enrollment or coverage, those who did not undergo chemotherapy, and those with capitated plans, our cohort consisted of 5,031 women. The median total medical expenditures per patient during the first year after the index procedure were $93,632 (interquartile range $62,319–140,140). Inpatient services accounted for $30,708 (interquartile range $20,102–51,107; 37.8%) in expenditures, outpatient services $52,700 (interquartile range $31,210–83,206; 58.3%), and outpatient drug costs $1,814 (interquartile range $603–4,402; 3.8%). The median out-of-pocket expense was $2,988 (interquartile range $1,649–5,088). This included $1,509 (interquartile range $705–2,878) for outpatient services, $589 (interquartile range $3–1,715) for inpatient services, and $351 (interquartile range $149–656) for outpatient drug costs.The average cost of care for women with ovarian cancer in the first year after surgery is approximately $100,000. Patients bear approximately 3% of these costs in the form of out-of-pocket expenses.