Treatment for advanced ovarian cancer includes initial tumor cytoreductive surgery (PDS) or neoadjuvant chemotherapy (NACT). Randomized controlled studies have found overall survival to be similar for these two regimens. One study found that for patients 65 years of age or older, there were more comorbidities and a lower rate of completion of all chemotherapy for those receiving PDS. The authors applied a 5-year Markov model analysis to analyze the economic cost-effectiveness of the two regimens. The group 1 model was followed by 6 cycles of carboplatin/paclitaxel regimen chemotherapy after PDS. Group 2 models underwent intermediate tumor cytoreduction after 3 cycles of carboplatin/paclitaxel regimen chemotherapy and then continued with 3 cycles of carboplatin/paclitaxel regimen chemotherapy. Parameters included OS, surgical comorbidity, likelihood of initial treatment, cost of treatment, and quality of life, and the results of OS were assumed to be equivalent to the findings of an international randomized controlled study. The difference in surgical complexity was calculated by adding the cost of additional surgical operations to the base surgical cost, weighted by incidence. The result was a cost savings of $5616 for NACT for the same survival. If PDS could improve OS by a median of 1.5 months or longer, the economic benefit of PDS would reach the $100,000/quality-adjusted life-year threshold. If PDS improves OS by a median of 3.2 months or longer, the economic benefit of PDS would be $50,000/quality-adjusted life-year. This model is solid and reliable in terms of changes in cost and comorbidity rates. the reduction in NACT-related quality of life would result in a more cost-effective value for PDS. Thus, the RCT-based model suggests that neoadjuvant chemotherapy is less costly for patients with advanced ovarian cancer aged 65 years or older. A slight increase in overall survival with initial tumor cell reduction or a modest decrease in quality of life with neoadjuvant chemotherapy both lead to a $100,000/quality-adjusted life-year cutoff for the initial procedure.