OBJECTIVES: Long-acting β2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) have shown efficacy in preventing exacerbations in patients with COPD. Though these agents are effective in the treatment of COPD, deterioration in the patient health status can persist and therefore there is a need for improved treatment outcomes. In the SPARK trial, dual bronchodilation with QVA149 demonstrated advantages in reducing the risk of COPD exacerbations in severe and very severe patients when compared to single bronchodilation with tiotropium. The objective of the study was to stimate the clinical benefits and the budget impact associated with the use of indacaterol 110 μg/glycopyrronium 50 μg (QVA149) instead of tiotropium 18 μ, in severe and very severe COPD patients (GOLD C and D) in Portugal. METHODS: A cost-consequence model was developed using the SPARK study data to derive treatment outcomes associated to the use of QVA149 instead of tiotropium. Primary outcomes of interest were COPD exacerbations and direct cost for the NHS. Treatment outcomes and costs were estimated for a 1 year. Local data was used to identify the target population, resource use and overall treatment costs.  RESULTS: It is estimated that there are 11,239 GOLD C and D patients treated with tiotropium. Assuming that 20.5% of COPD patients see their primary care doctor with complaints about symptoms and exacerbations 2,304 of those patients could be treated instead with QVA149.  After 1 year of treatment with QVA 149 it is estimated that patients will experience 1,291 fewer exacerbations with a reduction of €136,544 in the overall treatment costs compared to treatment with tiotropium.  CONCLUSIONS: Symptom control in COPD is essential and evidence shows that dual bronchodilation with QVA149 brings benefits when compared to tiotropium. The use of QVA149 in symptomatic patients instead tiotropium may improve treatment outcomes and reduce overall costs for the Portuguese NHS.