The field of pharmacoeconomics began about 20 years ago and is rapidly evolving. Current methods-cost effectiveness, cost minimization, cost benefit, and cost utility-are described and compared. Cost effectiveness and cost utility are expected to become dominant methods. Most pharmacoeconomic trials in the past have used surrogate markers, such as reduction in low-density lipoprotein cholesterol, as outcomes, rather than definitive clinical events. Lipids trials in which clinical markers were used -The West of Scotland Coronary Prevention Study, the Pravastatin Limitation of Atherosclerosis in the Coronary Arteries, and Pravastatin, Lipids, and Atherosclerosis in the Carotid Arteries -are discussed. The use of clinical outcomes, such as reduction in risk for various coronary events, is advocated to produce more rigorous cost-effectiveness studies.
