For about 50% of the drugs it has been possible to monitor more than one of the same class, or for a similar indication (beta-blockers, ACE inhibitors, lipid lowering agents and antidepressants), although not always concurrently (Table 27.1). Having comparators has obvious advantages, but unlike a clinical trial, there are frequent confoun-ders that can make interpretation of differences difficult (Beggs et al, 1998). It is not always possible to provide a suitable comparator and it is not always desirable from the point of view of cost and the demands being made of practitioners. Even with comparators, it may be necessary to set up a specific study designed to elucidate a signal (Beggs et al., 1998). It is probably more cost effective to monitor two different types of drug than to monitor one and select another for the sole purpose of being a comparator.

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