OBJECTIVES: The aim of this study is to analyze if tiotropium bromide is an efficient alternative respect to ipratropium bromide and standard therapy, in the management of chronic obstructive pulmonary disease (COPD) patients in Spain. METHODS: Efficiency of the different alternative options in COPD treatment was evaluated with a cost-effectiveness analysis. Tiotropium bromide was compared to ipratropium bromide and standard therapy by means of a cost-effectiveness analysis that estimates life years gained (LYG) with tiotropium respect to alternatives, by combining mortality associated to COPD exacerbations with rates of exacerbations taken from two meta-analysis of head to head clinical trials. The time horizon of the study was 13 years, the mean life expectancy in COPD patients included in the clinical trials with tiotropium. Uncertainty was studied by successive univariant sensitivity analysis of key parameters of the model and a probabilistic sensitivity analysis. All costs were expressed in €2008 and a 3% discount rate was applied to costs and effects. The analysis took the perspective of the Spanish National Health System (NHS). RESULTS: Incremental cost-effectiveness ratio (ICER) when treating COPD patients with tiotropium versus standard therapy was €2873/LYG, and in patients treated with tiotropium versus ipratropium bromide was €4208/LYG. Univariant sensitivity analysis showed that results where most sensitive to COPD severity and the future costs of surviving patients. CONCLUSIONS: Treating COPD patients with tiotropium is an efficient alternative respect ipratropium bromide or standard therapy for the Spanish NHS.