OBJECTIVES: Recent Italian studies showed that ICS-containing (Inhaled corticosteroids) drugs are prescribed to more than 50% of COPD patients regardless of disease severity and treatment guidelines, creating unnecessary costs for NHS. This study aims at assessing potential saving on drugs expenditure due to increased compliance to GOLD guidelines. METHODS: Novartis Core-model framework was adapted to Italian setting. Patient cohort was defined by applying prevalence rate of treated COPD patients to Italian population (2.5% annual growth rate). Patients severity split and treatment pattern are obtained by combining results of two Italian observational studies (reflecting GPs and pneumologists setting), assumed to be constant over 5 years. Drugs considered: LAMA (Long-acting muscarinic antagonist), LABA (Long-acting β2-agonist), Fixed-Dose Combination (LABA+ICS), SABA (Short-acting β2-agonist), add-on ICS. Based on reimbursed net public price, daily treatment costs for drugs are calculated. To calculate annual treatment cost, 50% compliance for all drugs (except 30% for ICS) and annual discounting rate of 3.0% are assumed. Following GOLD treatment scheme, Mild and Moderate patients, receiving long-acting bronchodilators and/or add-on ICS, were assigned respectively to SABA and LABA/LAMA alone. Difference in drugs costs between current and modified treatment pattern is calculated. RESULTS: Potential saving, calculated for Italy, was €160.2 million (36.4% of total drug costs) in year 1, and €793.4 million (36.4%) over 5 years. Analysis was extended to regional populations, resulting in one-year savings of: €26 million in Lombardy, from €10 million to €15 million in Campania, Lazio, Sicily, Veneto, Piedmont, Emilia Romagna, Apulia, Tuscany, from €3 million to €5 million in Calabria, Sardinia, Liguria, Marche, Abruzzo, Friuli-Venezia Giulia, Trentino-Alto Adige, and up to €2 million in Umbria, Basilicata, Molise, Aosta Valley. Results were compliance-sensitive. CONCLUSIONS: Adhering to GOLD guidelines, apart from having patients treated appropriately, National/Regional Healthcare Systems could save significant resources and re-allocate them in more rational manner.