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Targeted cancer therapies make it possible to tailor cancer treatment. This individualization of treatment is based on the unique set of molecular targets produced by a patient’s tumor. By administering selective therapies, efficacy can be improved over current treatments with fewer normal cells harmed, thus lowering the occurrence of possible side effects and improving quality of life.The monoclonal antibody trastuzumab, which targets HER2-overexpressing breast cancers, is an example of such a promising therapy. However, in comparison with the average wholesale price of other cancer therapies, monoclonal antibodies are relatively expensive. Economic evaluations are needed to clarify whether these expensive therapies offer value for money.In the metastatic setting, trastuzumab was evaluated as being relatively expensive; in Belgium, the incremental cost-effectiveness ratio was calculated to be €39 192 per life-year saved (2003 values). The cost effectiveness of trastuzumab could be improved by reducing drug costs and/or improving survival.In the adjuvant setting, trastuzumab treatment may result in a much better incremental cost-effectiveness ratio compared with use in the metastatic setting if treatment decreases the transition probabilities of cancers progressing to metastatic disease. This would both improve health outcomes and save on expensive future treatments. Nevertheless, treatment with monoclonal antibodies will imply higher immediate costs. In Belgium, with 6628 new cases of detected breast cancer in 1998, extra initial budget expenses by reimbursing trastuzumab for stage II and III breast cancer would have amounted to €25 569 084 per year. If this treatment leads to fewer cancers progressing to metastatic disease, long-term budget impact analyses should take the related future cost savings into account.If monoclonal antibodies prove to be cost effective, careful resource planning will be needed to be able to offer these treatments to all suitable patients.