OBJECTIVES: To estimate the budget impact of the inclusion of tiotropium bromide compared to ipratropium bromide on the top of standard COPD treatment scheme with long-acting bronchodilators. METHODS: The one-year budget impact analysis was conducted. Direct expenses associated with COPD exacerbations and resulting follow-up costs were calculated using general tariff agreement of Russian obligatory insurance system and official national statistics.  For reference, accepted exchange rate was 1 EUR = 40 RUB. RESULTS: Tiotropium bromide inclusion into the standard COPD therapy provided cost saving benefits compared with inclusion of ipratropium bromide in the COPD standard therapy scheme. Total costs of COPD therapy were approximately 259,730 RUB (6,493 EUR) per patient in tiotropium bromide group and 266,887 RUB (6,672 EUR) per patient in ipratropium bromide group within one year. Treatment of COPD using standard therapy with tiotropium bromide inclusion compared to one with ipratropium bromide leads to cost savings of 7,157 RUB (179 EUR) per patient-year. CONCLUSIONS: The results of budget impact analysis illustrate that including tiotropium bromide into the standard therapy of COPD instead of ipratropium bromide has potential to reduce Russian health care system total costs for COPD treatment.