OBJECTIVES: To evaluate the long-term cost-effectiveness of umeclidinium bromide 62.5 mcg OD (UMEC) compared to tiotropium bromide 18 mcg OD (TIO) for the maintenance treatment of COPD from the UK National Health Service perspective METHODS: We utilized a recently developed, internally and externally validated linked equations COPD Cohort disease progression modelThe treatment effect, expressed as change from baseline in forced expiratory volume in one second (FEV1) at 12 and 24 weeks estimated from a Bucher method indirect treatment comparison (ITC) analysis following a systematic review. UMEC price was set at parity price of £33.5/month to TIO. Model outcomes included exacerbations, life years, quality adjusted life years (QALYs) and costs/QALY. The time horizons investigated ranged from one to 20 years (lifetime) on a sliding one-year increment. Costs, survival, and QALYs after the first year were discounted at a rate of 3.5%. Healthcare costs were obtained from NHS reference costs (2011-12). Sensitivity analyses were performed to evaluate the robustness of the model to variations in the underlying input parameters and assumptions. RESULTS: The ITC estimated change from baseline in trough FEV1 of 18.06mL (95%CI: -19.11, 55.23, p=0.341) at 12 weeks and 3.97mL (95%CI: -38.30, 46.25, p=0.854) at 24 weeks for UMEC compared with TIO. At price parity, UMEC dominated TIO with incremental QALY of 0.0009, incremental life years of 0.0001 and cost reduction of £4.54. The sensitivity analyses suggested that variation in main parameters will not alter the behavior of the comparison between the two treatments. CONCLUSIONS: At price parity to TIO, UMEC may be considered as a cost-effective treatment alternative for maintenance bronchodilator treatment to relieve symptoms in patients with COPD in the UK.