OBJECTIVES: Glaucoma is a condition affecting one or both eyes with raised intraocular pressure (IOP). Target IOP should be reduced to 15 mm Hg to prevent progression of visual field loss. The objective of the present study was to perform and compare two country-specific cost-effectiveness analyses of bimatoprost 0.03% (Lumigan) compared with latanoprost 0.005% (Xalatan) as a second-line mono-therapy for glaucoma patients in Austria and Finland. METHODS: Revealing identical practice patterns in glaucoma treatment in Austria and Finland a decision model based on effectiveness and resource-use data from a multinational RCT was constructed. The RCT covered 269 adult patients with inadequately controlled IOP. In the model country-specific unit costs were used and cost-effectiveness was analysed from a societal perspective within a 12-months time horizon. The measure of effectiveness was "patients achieving target IOP". To handle uncertainty sensitivity analyses (one-way, break-even, extreme scenario) were undertaken. RESULTS: The RCT showed that 36% of the patients using bimatoprost achieved target IOP opposed to 22% using latanoprost. In the Austrian cost-effectiveness analysis bimatoprost (€2279 per patient achieving target IOP) showed to be cost-effective compared with latanoprost (€3917). With nearly identical ratios the same result appeared for Finland (bimatoprost: €2317; latanoprost: €3998). The relative decrease in the costs using bimatoprost was therefore 42% in both countries per patient achieving target IOP. The major reason to this difference was the extra need for adjunctive therapies using latanoprost. For all IOP-target levels in the range 12-18 mm Hg bimatoprost was cheaper and more effective (dominating strategy). CONCLUSION: Bimatoprost showed to be a more cost-effective second-line mono-therapy for glaucoma treatment in Austria and Finland. The study furthermore showed that at least for the two countries it seems possible to transfer cost-effectiveness results between countries and still arrive at the same recommendations for decision-making.