OBJECTIVES: Using data from a recently published head to head clinical trial comparing the efficacy and safety of the fixed combination bimatoprost/timolol (BTFC, Ganfort®) versus fixed combination latanoprost/timolol (LTFC, Xalacom®), the objective was to investigate the cost-effectiveness of BTFC versus LTFC in 10 European countries. METHODS: A model was developed to evaluate the cost-effectiveness of BTFC versus LTFC taking a health care perspective including only direct health care costs. Efficacy data originated from a recent head to head trial of BTFC and LTFC. Outcomes where measured as percentage reduction in intraocular pressure (IOP) from baseline and percentage of patients achieving >15% and >20% reduction in IOP from baseline, respectively. Safety was not included in the base case analyses as no significant differences were found in the tolerability of BTFC and LTFC in the clinical study. National unit costs were applied. The time horizon of the model was 3 months. Sensitivity analyses were performed to test the results responsiveness to changes in key input parameters.  RESULTS: Significantly more BTFC patients experienced >15% and >20% reduction in IOP compared to LTFC (p=0.003, p<0.001). Furthermore, 3-month health care costs for patients treated with BTFC were lower or comparable to those of LTFC in the 10 studied countries. Results were largely insensitive to changes in key parameters. The cost-effectiveness analyses revealed that BTFC was less costly and more effective than LTFC in 8 out of the 10 studied countries (Spain, Italy, Germany, UK, Netherlands, Norway, Sweden and Denmark) and more effective at equal health care costs in France and Finland. Therefore, BTFC was a dominating treatment strategy in all countries. CONCLUSIONS: BTFC is an effective treatment strategy in terms of lowering IOP and is a cost-effective treatment strategy for patients with glaucoma.