ORIGINAL STUDY
Daily Cost of Glaucoma Medications in China
Ying Gao, MD, Lingling Wu, MD, and Aijun Li, MD
Purpose: To determine and compare the daily cost of various
glaucoma medications in China.
Materials and Methods: The majority of glaucoma medications
commercially available in China were included in this research.
The total number of drops in 1 bottle of each medication was
counted drop by drop. The mean volume per bottle of each
medication was calculated. The cost per drop, number of days
for both eyes usage per bottle, and daily cost was calculated.
Results: (1) The volume per drop ranged from 0.03 mL
(brinzolamide 1%, travoprost 0.004%, bimatoprost 0.03%,
and latanoprost 0.005%) to 0.05 mL (timolol 0.5%—Chengrui
and pilocarpine 0.5% and 2%—Zhenrui). (2) The cost per bottle
ranged from $0.69 (US dollar) (timolol 0.5%—Malaisuan
Saimaluo’er) to $40.78 (latanoprost 0.005%). (3) The number
of days for both eyes usage per bottle ranged from 52 days
(bimatoprost 0.03%) to 11 days (pilocarpine nitrate 0.5%—
Zhenrui). (4) The daily cost for both eyes usage from expensive
to cheap were latanoprost 0.005%—$0.91, travoprost 0.004%—
$0.77, brimonidine 0.2%—$0.61, bimatoprost 0.03%—$0.46, D-
timolol 1%—$0.36, brinzolamide 1%—$0.34, pilocarpine 2%—
Zhenrui—$0.28, levobunolol 0.5%—$0.25, betaxolol 0.25%—
$0.24, pilocarpine 0.5%—Zhenrui—$0.18, pilocarpine 2%—Hum-
ing—$0.16, carteolol 1%—Mikelan—$0.15, carteolol 2%—Mike-
lan—$0.15, pilocarpine 1%—Huming—$0.10, timolol 0.5%—
Chengrui—$0.08, timolol 0.5%—Malaisuan Saimaluo’er—$0.03.
Conclusions: The daily cost of glaucoma medications in China
ranged much more wildly than developed countries. These data
may be useful in selecting medications for glaucoma therapy.
The ophthalmic solution of prostaglandins is powerful in
reducing intraocular pressure. However, its high price should
be considered when selecting glaucoma medications in China.
Key Words: glaucoma, medicine, cost
(J Glaucoma 2007;16:594–597)
T he kinds of glaucoma medications increased rapidly in
the last few years. New glaucoma medications such as
prostaglandins have increased efficacy, reduced dosing
Received for publication September 14, 2006; accepted March 24, 2007.
From the Peking University Third Hospital, Peking University Eye
Center, Beijing, China.
This research did not receive any financial support. And none of the
authors has proprietary interests of the manuscript.
Reprints: Wu Lingling, MD, Peking University Third Hospital, Peking
University Eye Center, Beijing 100083, China (e-mail: wllc@
mail.hz.zj.cn).
Copyright r 2007 by Lippincott Williams & Wilkins
594
regimens, and improved side-effect profiles. And the
prices of glaucoma medications also ranged more widely.
According to some surveys, the cost of medical therapy
has a considerable impact on the compliance in glaucoma
patients.1,2 It is much more obvious in developing
countries such as China. The calculated daily cost of
glaucoma medical therapy is helpful for glaucoma
medication selection. Therefore, estimation of daily cost
was made in this study on the majority of glaucoma
medications commercially available in China, including
b-adrenergic blockers, a-adrenergic agonists, cholinergics,
carbonic anhydrase inhibitors, and prostaglandins. This is
a cost-minimization study, and all the medications
included are assumed to have equal efficacy. Despite the
fact that this cost minimization has limitations, it serves
at least as a guide of pricing of medications that could
help to better understand the cost effectiveness of
medications in treating glaucoma.
MATERIALS AND METHODS
All the imported and domestic generic glaucoma
medications commercially available in Beijing, including
the majority of the widely used glaucoma medications in
China, were included in this research. Seven b-adrenergic
blockers and 9 other preparations were included in the
research (Table 1). Each bottle was labeled as containing
5 mL per bottle except for the 2.5-mL bottles of
latanoprost 0.005% (Xalatan, Pfizer) and travoprost
0.004% (Travatan, Alcon) and the 3-mL bottle of
bimatoprost 0.03% (Lumigan, Allergan). Five bottles of
each medications were kept at room temperature, 221C
for more than 24 hours before they were tested separately
by 5 researchers at the same environment. The researchers
squeezed the bottles to make drops one by one and
calculated the number of drops of each bottle. The drops
of each bottle were collected in a tube and then measured
with a graduated cylinder. After the actual volume for
each bottle was measured, the mean number of drops per
bottle and the mean volume per bottle were determined.
The volume per drop was calculated by dividing the mean
volume per bottle by the mean number of drops per
bottle, the cost per drop was calculated by dividing the
market price by the mean number of drops in a bottle, the
number of days for both eyes usage per bottle was
calculated by dividing the mean number of drops in a
bottle by the number of drops administered daily for both
eyes. And the cost per day was calculated by multiplying
the cost per drop by the number of drops administered
daily for both eyes. The information of standard market
J Glaucoma  Volume 16, Number 7, October/November 2007
J Glaucoma  Volume 16, Number 7, October/November 2007 Daily Cost of Glaucoma Medications

price, a set single price for the patient, comes from State
No. d/Bottle

Dose*/d Eyes) (d)

Food and Drug Administration, PR China.
(Both

11
15
12
15
19
22
24

27
29
30
30
32
35

45
47
52
RESULTS
The actual volume per bottle, which was labeled as
QID
QID
QID
QID
TID
BID
BID

BID
BID
BID
BID
BID
BID

QD
QD
QD
5 mL, ranged from 4.15 (timolol 0.5%, Malaisuan
Saimaluo’er, Wuhan Wujing, China) to 4.87 mL (pilo-
carpine 1%, Huming, Yongguang, China). The volume
0.05 ± 0.004
0.04 ± 0.002
0.05 ± 0.002
0.04 ± 0.002
0.04 ± 0.005
0.05 ± 0.001
0.04 ± 0.003

0.04 ± 0.002
0.04 ± 0.001
0.04 ± 0.002
0.04 ± 0.001
0.04 ± 0.002
0.03 ± 0.001

0.03 ± 0.003
0.03 ± 0.001
0.03 ± 0.000
Drop (mL)
Volume/

per drop was 0.03 mL (brinzolamide 1%, Azopt, Alcon)

to 0.05 mL (timolol 0.5%, Chengrui, Zhengda Furuida,
China and pilocarpine 0.5% and 2%, Zhenrui, Zhengda
Furuida, China). The number of days for both eyes usage
per bottle varied from 11 days (pilocarpine 0.5%,
4.55B5.10
4.72B4.97
4.40B4.62
4.58B4.95
4.22B4.84
4.50B4.70
3.94B4.43

4.60B4.87
4.45B4.90
4.57B4.67
4.56B4.73
4.43B4.72
4.10B4.48

2.65 ± 0.036 2.62B2.70

2.55 ± 0.100 2.41B2.64
3.08 ± 0.047 3.01B3.11
Volume/Bottle (mL)

Zhenrui, Zhengda Furuida, China) to 35 days (brinzola-

mide 1%, Azopt, Alcon). The actual volume per bottle of
latanoprost 0.005% (Xalatan, Pfizer) and travoprost
4.86 ± 0.209
4.87 ± 0.106
4.50 ± 0.086
4.73 ± 0.150
4.69 ± 0.266
4.61 ± 0.077
4.15 ± 0.247

4.71 ± 0.114
4.64 ± 0.184
4.62 ± 0.043
4.64 ± 0.072
4.61 ± 0.122
4.28 ± 0.144

0.004% (Travatan, Alcon), which were labeled as

2.5 mL, were 2.65 and 2.55 mL. The volumes per drop
were both 0.03 mL. The number of days for both eyes
usage per bottle were 45 days and 47 days. The actual
volume per bottle of bimatoprost 0.03% (Lumigan,
119 ± 8.2 108B130

119 ± 3.1 116B124

115 ± 8.5 104B127

100B113
112B122
112B123
116B123
112B132
130B150

103 ± 2.5 100B105

98 ± 7.2 92B109

90 ± 7.6 82B100
No. Drops/Bottle
91 ± 4.2 8 6B96

92 ± 4.4 8 6B97

87 ± 2.4 8 3B89

94 ± 2.2 9 0B95

Allergan), which was labeled as 3 mL, was 3.08 mL. The

volume per drop was 0.03 mL. The number of days for
both eyes usage per bottle was 52 days (Table 1).
106 ± 6.3
116 ± 4.1
119 ± 4.3
119 ± 2.6
126 ± 8.4
141 ± 8.0

The price per bottle of the glaucoma medications

ranged from $0.69 (timolol 0.5%, Malaisuan Saimaluo’er,
Wuhan Wujing, China) to $40.78 (latanoprost 0.005%,
TABLE 1. Average Days for Both Eyes Usage Per Bottle of Glaucoma Medication (n = 5)

Xalatan, Pfizer). The daily cost for both eyes usage varied
Zhengda Furuida, China

Zhengda Furuida, China

Zhengda Furuida, China

Allergan, United States

Allergan, United States

Allergan, United States

from $0.03 (timolol 0.5%, Malaisuan Saimaluo’er,

Wuhan Wujing, China

Alcon, United States

Alcon, United States

Alcon, United States

Pfizer, United States
Manufacturer

Wuhan Wujing, China) to $0.91 (latanoprost 0.005%,

Yongguang, China

Yongguang, China

Yongguang, China

Xalatan, Pfizer) (Table 2).

Oostuka, China
Oostuka, China

*BID indicates twice per day; QD, once per day; QID, 4 times per day; TID, 3 times per day.

DISCUSSION
With an increasing older population and increased
rate of detection, the use of glaucoma medications is
increasing. Among people older than 40 years, there are
Saimaluo’er
Trade Name

approximately 9.4 million patients3 who have glaucoma

Malaisuan
Alphagan
Chengrui

Travatan
Lumigan

and may need medical therapy for long time or even for a
Betoptic
Mikelan
Mikelan
Huming

Huming

Levobunolol hydrochloride 0.5% Betagan

Xalatan
Zhenrui

Zhenrui

Dilijian
Azopt

life time. As a result, there has been an increase in

consumption of glaucoma medications. Another reason
for the increase should be the introduction of new, high-
Betaxolol hydrochloride 0.25%

cost medications. The increase of medical cost has a

Carteolol hydrochloride 1%
Carteolol hydrochloride 2%

considerable impact on patients and the health-care

Active Ingredient
Pilocarpine nitrate 0.5%

system. Daily cost is one of the important factors that

Pilocarpine nitrate 2%
Pilocarpine nitrate 1%

Pilocarpine nitrate 2%

D-timolol maleate 1%
b-adrenergic blocker Timolol maleate 0.5%
Timolol maleate 0.5%

go into this decision-making process, besides drug

Latanoprost 0.005%

Bimatoprost 0.03%
Travoprost 0.004%
a-adrenergic agonist Brimonidine 0.2%

efficacy, side-effect profile, and dosing frequency. Accord-

Brinzolamide 1%

ing to the result of this study, all domestic generic

medications cost less than $0.40 as does imported
brinzolamide. The cheapest one was timolol 0.5%
(Malaisuan Saimaluo’er, Wuhan Wujing, China), which
cost only $0.03 daily. However, all topical prostaglandin
analogs and brimonidine cost at least $0.40 daily or more.
Carbonic anhydrase

And the most expensive glaucoma medication in China

Generic Names

was latanoprost 0.005%, which cost $0.91 daily. In

Prostaglandins

America, Japan, and some European countries, similar

Cholinergic

inhibitor

studies have been conducted to examine drop size, fill

volume, and predicted daily cost of glaucoma medica-
tions.4–11 In America, the most expensive medication was

r 2007 Lippincott Williams & Wilkins 595

Gao et al J Glaucoma  Volume 16, Number 7, October/November 2007

TABLE 2. Daily Cost of Glaucoma Medications (n = 5)

Cost/d
Price US No. Drops/d Cost/Drop (Both Eyes)
Generic Names Active Ingredient Trade Name Manufacturer Dollar* (Both Eyes) US Dollar* US Dollar*
Cholinergic Pilocarpine nitrate 1% Huming Yongguang, China 1.53 8 0.01 0.10
Pilocarpine nitrate 2% Huming Yongguang, China 2.32 8 0.02 0.16
Pilocarpine nitrate 0.5% Zhenrui Zhengda Furuida, 2.05 8 0.02 0.18
China
Pilocarpine nitrate 2% Zhenrui Zhengda Furuida, 3.26 8 0.04 0.28
China
b-adrenergic Timolol maleate 0.5% Malaisuan Wuhan Wujing, China 0.69 4 0.01 0.03
blocker Saimaluo’er
Timolol maleate 0.5% Chengrui Zhengda Furuida, 1.66 4 0.02 0.08
China
Carteolol hydrochloride 1% Mikelan Oostuka, China 4.34 4 0.04 0.15
Carteolol hydrochloride 2% Mikelan Oostuka, China 4.34 4 0.04 0.15
Betaxolol hydrochloride Betoptic Alcon, United States 6.99 4 0.06 0.24
0.25%
Levobunolol hydrochloride Betagan Allergan, United States 6.76 4 0.06 0.25
0.5%
D-timolol maleate 1% Dilijian Yongguang, China 11.30 4 0.09 0.36
Carbonic Brinzolamide 1% Azopt Alcon, United States 12.00 4 0.09 0.34
anhydrase
inhibitor
Prostaglandins Bimatoprost 0.03% Lumigan Allergan, United States 23.89 2 0.23 0.46
a-adrenergic Brimonidine 0.2% Alphagan Allergan, United States 11.61 6 0.10 0.61
agonist
Prostaglandins Travoprost 0.004% Travatan Alcon, United States 35.95 2 0.38 0.77
Latanoprost 0.005% Xalatan Pfizer, United States 40.78 2 0.45 0.91
*1 US dollar = 8.2889 Yuan.

latanoprost ($1.25/d), which cost 3 times as much as the
cheapest one, timolol ($0.38/d).6 In Japan, the daily cost
of latanoprost and timolol were almost the same ($0.44/
d).7 However, in China, the most expensive medication,
latanoprost ($0.91/d), cost 33 times as much as the
cheapest one, timolol ($0.03/d). Comparing with devel-
oped countries, the cost of glaucoma medications range
much more wildly in China.
Although the standard market price in China for
each medication is regulated by national agency, the price
of medications may change. However, the results of this
study, more specifically, the average number of drops per
bottle or average number of days for usage per bottle may
be useful to recalculate an updated daily cost when the
price changes. This study is based on a best-case scenario
for all medicines and does not account for wasted doses,
the frequency of refills, or a medication’s success or
failure rate. In this study, all of the domestic generic
glaucoma medications and most of the imported eye
drops except latanoprost, travoprost, and bimatoprost
are under filled compared with the label claim. It may
partly result from the volatilization loss or inaccuracy of
measurement. The table of number of drops (Table 1)
showed the range found across the 5 bottles. The manner
in which we dispense the drops influences the size of the
drops.12 Holding the dropper bottle vertically can help
minimize drop size. Squeezing the bottle gently and
slowly induces a low drop formation rate, ensuring that
only 1 drop of the medication will be formed, and that
drop will have a reduced volume. In this study, we held
the bottles as vertically as possible and squeezed the
bottles as gently as possible, but there is still variation
of number of drops of the same medication between
different researchers.
In 1970s, patients were often started on a topical
b-blocker, but the contraindications such as asthma,
chronic obstructive pulmonary disease limited its applica-
tion in some. Since later 1990s, some newer glaucoma
medications such as prostaglandins, topical carbonic
anhydrase inhibitor, and a2-adrenergic agonist had been
brought into use. Some of them have been commercially
available in China by now, but some medications such as
Trusopt, Cosopt, Combigan, and Xalcom are still not
available. The true costs of some newer medications may
be further decreased by improved compliance, the need
for fewer medications to control intraocular pressure,
fewer patient interventions (such as office calls, surgeries,
lasers), and an improved side-effect profile. However,
with all the factors above considered, some of the newer
medications may be still too expensive in China,
especially in the rural area. Take prostaglandins for
example, the average cost of prostaglandins was $0.71/d.
According to the data from the Nation Bureau of
Statistics of China,13 in 2004, the average income per
person was $0.97/d in rural and $3.11/d in urban. The
average cost on food per person was $0.34/d in rural and
$0.90/d in urban. And the average cost on housing per
person was $0.11/d in rural and $0.24/d in urban. And

596 r 2007 Lippincott Williams & Wilkins

J Glaucoma  Volume 16, Number 7, October/November 2007
the costs of surgeries are also quite expensive. The cost of
laser trabeculoplasty was $36.19 to $72.39. The cost of
filtration surgery was $72.39. There is basic medical
insurance for most of the citizens in China, which means
the government will pay 80% of the further medical cost
for a patient when he/her has paid $241 by himself/
herself. However, there is no basic medical insurance for
most people in the rural area and some people in the city.
Furthermore, in most cities of China, basic medical
insurance system does not cover the newer medications of
glaucoma, such as prostaglandins and topical carbonic
anhydrase inhibitor. In some parts of China, especially in
the rural area, traditional treatments such as acupuncture
are still regarded as a costless therapy of glaucoma,14 but
the effectiveness remains to be verified. And there are
some parts of rural area, to which even the treatments
with the lowest daily cost are not accessible. Nowadays,
prostaglandins have become a first-line therapeutic option
in developed countries because of its effective intraocular
pressure-lowering ability, minimal risk of systemic side
effects, and once-daily administration.15–20 But in China
the daily cost is still a main factor to be considered when
choosing a medication for a patient with glaucoma.
Further researches will be conducted to study the cost
effectiveness of different glaucoma medications in China.
REFERENCES
1. Tsai JC, McClure CA, Ramos SE, et al. Compliance barriers in
glaucoma: a systematic classification. J Glaucoma. 2003;12:393–398.
2. Taylor SA, Galbraith SM, Mills RP. Causes of non-compliance with
drug regimens in glaucoma patients: a qualitative study. J Ocul
Pharmacol Ther. 2002;18:401–409.
3. Wang N. Issues and strategies of glaucoma prevention and
treatment in nowadays. Chin J Ophthalmol. 2002;138:705–707.
4. Fiscella RG, Green A, Patuszynski DH, et al. Medical therapy cost
considerations for glaucoma. Am J Ophthalmol. 2003;136:18–25.
r 2007 Lippincott Williams & Wilkins
Daily Cost of Glaucoma Medications
5. Steven DV, William LR, John J. Cost Analysis of glaucoma
medications: a 3-year review. J Glaucoma. 2002;11:354–358.
6. Fiscella R, Geller JL, Gryz LL, et al. Costs considerations of
medical therapy for glaucoma. Am J Ophthalmol. 1999;128:426–433.
7. Hiroaki I, Eiji S, Teruaki K, et al. Daily cost of ophthalmic solutions
for treating glaucoma in Japan. Jpn J Ophthalmol. 2001;45:99–102.
8. Calissendorff BM. Consumption of glaucoma medication. Acta
Ophthalmol Scand. 2001;79:2–5.
9. Mick AB, Gonzalez S, Dunbar MT, et al. A cost analysis of the
prostaglandins analogs. Optometry. 2002;73:614–619.
10. Stewart WC, Hudgins AC, Pruitt CA, et al. Daily cost of newer
glaucoma agents. J Ocul Pharmacol Ther. 1999;15:379–388.
11. Stewart WC, Sine C, Cate E, et al. Daily cost of beta-adrenergic
blocker therapy. Arch Ophthalmol. 1997;115:853–856.
12. Luc VS, Annick L. Determinants of eye drop size. Surv Ophthalmol.
2004;49:197–214.
13. Nation Bureau of Statistics of China. China Statistical Yearbook
2005. Beijing: Nation Bureau of Statistics of China; 2005.
14. Xuejing LU, Aiqin LIU, Liao P. A review of literature on present
situation of glaucoma for research and treatment with acupuncture.
Chin Tradit Ophthalmol. 2003;13:119–121.
15. Bernard LM, Althin R, Dhawan R, et al. Clinical and economic
impacts of latanoprost 0.005% in first-line treatment of open-angle
glaucoma and ocular hypertension in France. Eur J Ophthalmol.
2003;4:S30–S43.
16. Perry CM, McGavin JK, Culy CR, et al. Latanoprost: an update of
its use in glaucoma and ocular hypertension. Drugs Aging. 2003;20:
597–630.
17. Costagliola C, Parmeggiani F, Sebastiani A. Assessing the cost-
effectiveness of switching from a beta-blocker to latanoprost in the
treatment of ocular hypertension. Expert Opin Pharmacol Ther.
2003;4:1775–1788.
18. Stewart WC, Leech J, Sharpe ED, et al. An economic analysis of
switching to latanoprost from a beta-blocker or adding brimonidine
or latanoprost to a beta-blocker in open-angle glaucoma or ocular
hypertension. Am J Manag Care. 2002;8(suppl 10):S240–S248.
19. Baudouin C, Rouland JF, Le Pen C. Changes in medical and
surgical treatments of glaucoma between 1997 and 2000 in France.
Eur J Ophthalmol. 2003;13(suppl 4):S53–S60.
20. Schwartz K, Budenz D. Current management of glaucoma. Curr
Opin Ophthalmol. 2004;15:119–126.
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