OBJECTIVES: In glaucoma patients, the long term use of prostaglandin eye drops containing benzalkonium chloride (BAK) increases the risk of developing an ocular surface disease (OSD). Polyquad® preserved prostaglandins are now available, among which travoprost proved similar in efficacy and safety compared to BAK-preserved formulations. We aimed to estimate the impact of Polyquad® instead of BAK on glaucoma management cost. METHODS: A Markov microsimulation model was developed in TreeAge, including 5 health states corresponding to 4 treatment lines plus death, in representative, treatment-naive patients at different OHT/glaucoma stages. The sequence travoprost-travoprost+timolol fixed combination preserved with Polyquad® was compared to BAK-preserved latanoprost-latanoprost+timolol (LAT) and bimatoprost-bimatoprost+timolol (BIM). The model events were: onset of OSD (risk factors: age, sex, BAK exposure; sources: US incidence study [Moss 2005], Erb 2008), need for treatment change including surgery/laser (risk factors: treatment line, disease stage, OSD presence, BAK exposure; sources: persistence studies in UK GPRD [Lafuma 2007] and US claims database [Schmier 2010]), and disease progression (risk factors: treatment line, OSD severity, non-compliance; sources: large prospective studies in OHT/glaucoma). Costs data came from a German observational study in OHT/glaucoma with 5-year retrospective collection of medical resources used (Statutory Health Insurance perspective + patient co-payments; 2011 drug costs, other costs 2010). The 95% confidence intervals came from a probabilistic sensitivity analysis. RESULTS: After 10 years, the total management cost in the travoprost with Polyquad® arm was €4677 [4378;5013] compared to €5196 [4904;5482] with LAT and €5342 [5069;5664] with BIM. More patients required eye surgery/laser procedures with BAK-preserved sequences (LAT: 4.7% [3.2;6.4%], BIM: 6.0% [4.0;8.3%]) compared to travoprost with Polyquad® (1.8% [0.9;2.9%]). CONCLUSIONS: At 10 years, prostaglandin treatment with Polyquad® is expected to reduce the cost of glaucoma treatment by 10-15% from both individual and societal perspectives, and have lower surgery/laser rates compared to BAK-preserved treatments.