OBJECTIVES: To estimate the cost-effectiveness of a novel LAMA, glycopyrronium ( Seebri® Breezhaler), compared with tiotropium (Spiriva®) in COPD patients from a Swedish societal perspective. METHODS: A probabilistic Markov model was utilized to simulate the progressive course of COPD and its impact on quality adjusted life years (QALYs) in moderate to severe patients. Effectiveness was based on initial FEV1 increase included by using patient level improvement in one or more disease severity stages (according to GOLD guidelines) and annualized risk for exacerbation as observed in a 1-year head-to-head randomized controlled trial (GLOW2). Initial FEV1 increase during the first year was followed by a constant decline in FEV1 in subsequent cycles. Based on list prices, annual drug costs were 3’825 Swedish krona (SEK)/447 EUR for glycopyrronium and 5’040 SEK/589EUR for tiotropium. Direct and indirect maintenance and exacerbation costs as well as utilities were extracted from published literature. Primary outcomes were QALYs and societal costs over 3 years, discounting future costs and benefits at 3%. Both one way and probabilistic sensitivity analysis have been performed. RESULTS: Over 3 years, glycopyrronium was found to be dominant (i.e. less costly and more effective) compared with tiotropium. Treatment with glycopyrronium resulted in a minor QALY gain of 0.005 compared with tiotropium. Total costs per patient were estimated at 73’752SEK /8’630 EUR for glycopyrronium and 79’357 SEK /9’286 EUR for tiotropium, resulting in an average cost saving of 5’605SEK /656 EUR per patient after 3 years. Univariate sensitivity analyses showed that base-case results were robust and probabilistic sensitivity analyses resulted in 99% of generated samples with glycopyrronium to be dominant. CONCLUSIONS: From a Swedish societal perspective, glycopyrronium was estimated to be cost-effective compared with tiotropium based on the progressive course of COPD and risk for exacerbation in moderate to severe patients as observed in the head-to-head study GLOW2.