OBJECTIVES: To assess the cost-effectiveness and cost-utility of glycopyrronium bromide versus tiotropium bromide in Chronic Obstructive Pulmonary Disease (COPD) patients, from the Spanish National Health System perspective. METHODS: A Markov model was developed to compare glycopyrronium bromide and tiotropium therapies. Progression of a COPD patient cohort was simulated for a 5-year time horizon (3 months-cycle duration). The health states included were defined according to the severity of COPD: mild, moderate, severe, very severe and death (absorbent). Three additional sub-states: without exacerbation, mild and severe exacerbation were considered. The effectiveness of treatment options and utilities for each health state were taken from the literature. Only direct healthcare costs were considered. Disease management and exacerbation costs were obtained from the literature. Drug costs were calculated based on ex-factory prices with mandatory 7.5% rebate. All costs were updated to €2012. A 3% annual discount rate on costs and health outcomes was applied. Incremental ratios in terms of cost per life-year gained (LYG) and cost per quality-adjusted life-year gained (QALY) of the most effective therapy versus the comparator were calculated. One-way sensitivity analyses were performed modifying the following parameters: time horizon (10 years, lifetime), discount rate (0%, 5%), drug costs (±10%, ±20%) and utilities (±10%). Probabilistic sensitivity analysis (PSA) was also performed. RESULTS: At 5 years, glycopyrronium bromide accounted a total cost of €2,225.18 compared to €2,374.81 accounted for tiotropium bromide. Glycopyrronium bromide yielded higher health benefits (4,321 LYG and 3,388 QALY) than tiotropium bromide (4,315 LYG and 3,377 QALY). In all one-way sensitivity analyses performed and in 100% of PSA simulations (1,000 iterations), glycopyrronium bromide compared to tiotropium bromide remained as a dominant strategy. CONCLUSIONS: Glycopyrronium bromide therapy in COPD patients is associated to less costs and higher health benefits than tiotropium in Spain.