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BACKGROUND Economic evaluations in healthcare are continuously being developed and increasingly applied. Health technology assessments provide insights into the health benefits of medical interventions compared to the treatment costs. OBJECTIVE and DESIGN This article gives an overview of historical, current and future developments in health economics, with a broader perspective on control of healthcare costs in the Nether-lands. RESULTS At national level, pharmacoeconomics play a major role when reimbursement is requested for a medical intervention. Pharmacoeconomic outcomes are increasingly used for price negotiations to arrive at a cost-effective price for the Netherlands. New trends are introductions to the market with market access agreements, the inclusion of real world evidence and the exploration of realizing reimbursement of medicines at European level instead of per country. CONCLUSION Economic evaluations in healthcare provide insights into costs, savings and health effects of new treatments, and are performed in line with strict national and international requirements. The Dutch government applies these evaluations when deciding on the reimbursement of medical interventions. The aim of the government is to gain maximum health benefits for society within the total healthcare budget. [ABSTRACT FROM AUTHOR]