OBJECTIVES: Ganfort is a fixed combination product containing bimatoprost 0.03% and timolol 0.5% indicated for lowering IOP of patients with glaucoma or ocular hypertension. Other fixed combination products such as Xalacom (latanoprost 0.005% and timolol 0.5%) and Duotrav (travoprost 0.004%and timolol 0.5%) are also available on the market. All products have the advantage of being more convenient for the patient due to once-daily administration. Since no head to head studies compare the three combination products, an indirect comparison is used based on available clinical data. The purpose was to investigate the cost-effectiveness of the three fixed combination therapies in eight European countries. METHODS: A systematic literature search was conducted in order to identify randomized clinical trials of Duotrav and Xalacom. Studies were selected which had reduction in IOP as primary endpoint and which were comparable with data from randomized controlled trials of Ganfort with respect to study design, diagnosis and patient population, so that an indirect comparison could be conducted. A decision analytic cost-effectiveness model was constructed. The cost evaluated was cost of medication and clinical visits to an ophthalmologist. All drug costs are market prices inclusive of VAT and visit costs are priced using official tariffs. Patients discontinuing treatment due to adverse events were assumed to change therapy and had an extra clinical visit. RESULTS: The cost-effectiveness analysis showed that the cost per percentage reduction in IOP was least costly for Ganfort. By using Ganfort therapy, savings per percentage reduction in IOP ranged from €0.06 to €0.22 compared to Duotrav and €0.02 to €0.36 compared to Xalacom. CONCLUSION: This analysis concludes that Ganfort is more cost effective than Duotrav and Xalacom in United Kingdom, Denmark, Sweden, Norway, Finland, France, Italy and Spain. Thus, the cost per percentage reduction in IOP is lower for Ganfort compared to Duotrav and Xalacom.