OBJECTIVES: This study aimed at estimating the cost-effectiveness of the fixed-dose combination indacaterol/glycopyrronium 85/43μg (IND/GLY) against tiotropium 18μg (TIO) and salmeterol/ fluticasone 50/500μg (SFC) in the management of patients with COPD in Greece. METHODS: A microsimulation model was developed in MS Excel. Efficacy and utility data were obtained from the international literature (SHINE & ILLUMINATE studies) and mortality data from the WHO database. Distribution of patients by GOLD severity stage, maintenance costs and costs associated with severe/ non-severe exacerbations were taken from published Greek studies. Unit costs were taken from officially published sources (Price Bulletin, reimbursement list, DRGs). The study perspective was that of the Social Insurance Fund; costs and outcomes were discounted at 3.5%; outcomes are reported over time horizons of one, three, five and 10 years and over a lifetime. Cost base year was 2014. Deterministic and probabilistic sensitivity analyses were conducted to test robustness of model results. RESULTS: Treatment of COPD with IND/GLY is associated with increased efficacy both against SFC (additional life years [LYs]: 0.19; additional quality adjusted life-years [QALYs]: 0.13) and TIO (additional LYs: 0.22; QALYs: 0.16). Although IND/GLY has a higher pharmaceutical cost (additional €2,626 vs. SFC; additional €2,679 vs. TIO), all other cost components (maintenance costs, severe and non-severe exacerbation costs) are reduced, resulting in a reduction of total costs by €5,204 compared with SCF and €7,126 compared with TIO. The sensitivity analyses confirmed that IND/GLY was dominant in the majority of iterations, with a probability of being cost effective at a threshold of €30,000 per QALY gained of 99.9% and 97.1% versus SFC and TIO, respectively. CONCLUSIONS: IND/GLY was found to be a dominant treatment strategy compared to SFC and TIO for the management of patients with COPD in Greece, which could lead to savings for the healthcare system.