OBJECTIVES: In Germany, breast cancer is the most frequent cancer. In 2007, 7.2% of total German health care expenditure was spent on breast cancer. Despite, its important epidemiological and economic burden, literature on cost of chemotherapy in breast cancer is rather scarce in Germany. The objective of this study was to estimate the cost of adjuvant chemotherapy in early stage breast cancer in Germany, using two different perspectives: the sick funds and the society. METHODS: A semi-systematic search of the literature was conducted to identify relevant articles describing the cost of adjuvant chemotherapy in Germany. The electronic database Pubmed and a selection of congress databases were searched using combinations of search terms designed to identify publications describing cost of adjuvant chemotherapy in early stage breast cancer patients. Searches were limited to those published in the English and German language between January 2000 and April 2011. A retrospective multicentre study was conducted to collect chemotherapy-related resources used. Unit costs were collected from public sources (EBM catalogue, Rote list, DRG list). Cost items collected included: chemotherapy drugs, monitoring and administration, prevention and management of adverse events, transportation to the treatment centre, and when using the societal perspective, also sick leaves. RESULTS: A total of 51 patients were included the study. The following adjuvant chemotherapy regimens were given to the patients:  TAC (22%), FEC (20%), FEC+DOC (20%), TC (20%), EC+DOC/PAC (12%) and others (8%). The average total costs for an adjuvant chemotherapy treatment were estimated to be €11,036 in a sick fund perspective and €16,199 in a broader societal perspective. The direct costs were €5722 for chemotherapy drugs, €982 for chemotherapy administration and monitoring, €4228 for supportive drugs and management of adverse events. The indirect costs of sick leaves were €5163. CONCLUSIONS: Adjuvant chemotherapy represents a significant economic burden to the health care system and the society.