OBJECTIVES: To estimate the resource utilization and microcosting related to endocrine therapy (ET) versus chemotherapy (CT) in the treatment of hormonal receptor positive (HR+), advanced breast cancer (ABC) patients, after at least one previous ET, under the BPHS perspective. METHODS: This retrospective longitudinal study analyzed ABC patients receiving fulvestrant or CT between 2006 and 2008 in a public oncology outpatient service. The study sample was a convenience sample and included all eligible patients identified. Only patients without visceral crisis and with at least one previous hormonal therapy were considered eligible. Medical charts were reviewed by two investigators and information about diagnosis, course of treatment, and resource utilization was obtained. Unit costs were obtained from public Brazilian databases. RESULTS: Patients were all female and the mean age was 64.6 ± 12.6 years. Patients were well matched between groups considering baseline characteristics. Twenty-five patients were enrolled in the study, 13 patients received CT and 12 patients received fulvestrant. The most common CT regimen was paclitaxel (n = 5, 38%). The mean number of cycles was 7,6 and 5,8 for fulvestrant and CT, respectively. The mean treatment cost per patient was BRL16,679 (US$11,914; 2005 purchasing power parity index 1US$ = 1.4BRL) for fulvestrant and BRL32,946 (US$23,533) for CT. The mean cost per cycle was BRL2199 (US$1571) and BRL5710 (US$4079) for fulvestrant and CT, respectively, resulting in BRL3511 (US$2508) incremental cost per cycle. Medications were the largest contributor to overall cost, corresponding to 97% and 92% of total costs per cycle in the fulvestrant and chemotherapy groups, respectively. CONCLUSIONS: Our study results indicate that subsequent ET with fulvestrant can be economically appropriate among HR+ ABC patients. Further researches could validate these findings in other contexts, but we consider that our estimations reflect the real world clinical practice in Brazil.