OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is a progressive (and non-completely reversible) inflammatory lung disease. Disease progression is associated with increasing morbidity, mortality and economic burden. As compared to usual care, tiotropium treatment and pulmonary rehabilitation programs have been reported to improve the health of COPD patients in terms of exacerbations, quality of life, and mortality. However, to date, the cost-effectiveness/utility of these therapies in French settings have not been reported. We estimated the cost-utility/effectiveness of these therapies in a patient population recruited from French general practitioners and lung specialists. METHODS: A Markov model of the disease was developed and the study adopted society’s perspective while the horizon time considered was patient's remaining lifespan. Cohorts of COPD patients treated with Tiotropium or cohorts of patients undergoing pulmonary rehabilitation programs were simulated (Monte-Carlo simulations in TreeAge software) and compared to identical cohorts of patients subjected to usual care. Life expectancies, quality adjusted life-years (QALY), disease-related costs, and incremental cost-utility ratios were estimated. RESULTS: At the horizon of a patient's remaining lifetime (14.29 life years in average, considering a population combining moderate to very severe patients), tiotropium would result in 0.12 life years and 0.58 QALY gained (mean estimates), induce an additional cost of 5380 €/patient in the disease-related costs, with a corresponding incremental cost-utility ratio of 8853 €/QALY. For pulmonary rehabilitation programs, these estimates were 0 life years, 0.31 QALY, 2,969 €, and 12,000 €/QALY, respectively. Results were mostly sensitive to the utility changes associated with exacerbations. CONCLUSIONS: Tiotropium treatment and pulmonary rehabilitation programs were estimated as worth interventions in the studied population, below the usual threshold used for declaring procedures as cost effective. Nevertheless, the modest gains in health issued from the study emphasize the need of research for developing more effective COPD-related therapies.