Endocrine therapy has become an integral part of the management of breast cancer and its different clinical applications raise different economic issues. The low toxicity, good response and relatively low cost of agents makes endocrine therapy an attractive treatment option for breast cancer patients at different stages of their disease. The method, hypotheses and expectations from economic analysis of endocrine therapy depend on the objectives of treatment (preventive, curative or palliative), the therapies being compared, the population being treated and the clinical benefits expected. The economic and quality of life literature has focused mainly on the analysis of endocrine therapy in the adjuvant setting. As budgets continue to shrink and treatment guidelines become challenged by new therapeutic and preventive approaches, decision analysis in breast cancer management is likely to become more explicit. Economic analysis can be a useful tool to guide clinical decisions in the management of this complex and chronic disease. Ultimately, the positioning of endocrine therapy with respect to other complementary or alternative treatment modalities will depend on the level of expected effectiveness, and on finding the best therapeutic solution to meet the breast cancer patient's clinical situation, expectations and needs.