Economic assessments of treatment alternatives in breast cancer have been predominantly ones addressing the role and type of adjuvant therapy. These assessments have shown that the effectiveness of the intervention drives the cost-effectiveness results. Other key factors were the relative risk of recurrence, the time frame considered and only minimally the costs of the intervention. Assessments in advanced breast cancer are few in parallel with the limited number of phase III trials. Future assessments should address neoadjuvant therapy, high-dose adjuvant therapy and agents that alter disease associated complications agents such as biphosphonates.