Intensive care medicine is one of the most fast growing segments in medicine. New substances that may improve therapy of the critically ill dramatically have entered the market. Improvements include therapy of methicilline-resistant Staphylococcus aureus (MRSA) infections (linezolid), severe heart failure (calcium sensitizer levosimendan), intractable bleeding (recombinant factor VIIa) and severe sepsis (recombinant activated protein C (aPC)). The anticipations concerning this new strategies of intensive care therapy are high, but use of the new substances is associated with extreme costs. In the past, pharmaceutical therapy represented only a small aspect of all costs in the intensive care unit (ICU). Using this new substances, we are entering a new dimension of costs. One case of recombinant factor VIIa or recombinant aPC increases costs by approximately 10000,- Euro. At the moment, this costs are not covered by extra-budgets. It is still unclear whether by using this new therapeutic strategies other costs can be reduced and the extreme extra-costs can be balanced. The elderly population will increase dramatically in the next years. Looking at this development, it is not only the question whether we can afford intensive care medicine, but the question has to be enlarged whether we can afford the new developments of intensive care medicine. All responsible persons (intensivists, pharmaceutical companies, politicians) are urged to define solutions in the near future.