OBJECTIVES: According to the GOLD report (2011) COPD is associated with significant economic burden. COPD exacerbations account for the greatest proportion of the total COPD costs. Frequency and severity of COPD exacerbation could be reduced by the appropriate medication that could be reimbursed by Ukrainian Government. METHODS: To determine the net benefit ratio we assessed total COPD costs and the COPD exacerbation-related costs reduction as benefit (effectiveness) for tiotropium (18 mcg daily) and salmeterol  (50 mcg two times a day) compared to usual COPD treatment practice of GPs. Direct costs included medication costs, outpatient and inpatient costs. Indirect costs included productivity loss and temporary disability related payments. Calculations were performed per 1000 employed economically active COPD patients. The data about the outpatient visits and hospitalizations was received from results of Ukrainian retrospective study (for usual practice regimen) and from the POET study results (for tiotropium and salmeterol). Prices for medical services were received from appropriate survey (2011) and were counted with May 2011-May 2012 inflation index and salary growth rates. The minimal market medication prices (on 15 June 2012) were included in calculations. Sensitivity analysis was conducted with medication price decrease.      RESULTS: Results show that total COPD costs per 1000 employed economically active COPD patients in 2012 could amount €498052,34, €441697,07 and €508983,73 with usual COPD treatment practice of GPs, salmeterol  and tiotropium, respectively. Reduction of exacerbation-related COPD costs compared to usual practice  could amount €85698,78 for salmeterol and  €114380,78 for tiotropium. Cost benefit ratio for salmeterol could be 5,15 and for tiotropium could be 4,45. In case of 27% price drop salmeterol could be more beneficial than tiotropium. CONCLUSIONS: According to results of the cost-benefit analysis tiotropium is more beneficial for COPD basis in employed economically active Ukrainian population than salmeterol compared to usual practice. It could be reimbursed by Ukrainian government.