OBJECTIVES: The objective of this study was to assess the cost-utility of tiotropium administrated through the Respimat inhaler as an add-on controller therapy on top of usual care in patients with severe persistent asthma from both the public payer’s and common (patient and National Health Fund - NHF) perspectives in Poland. METHODS: The target population was adult patients with asthma, who are currently treated with the maintenance combination of inhaled corticosteroids (≥800 µg budesonide/day or equivalent) and long-acting β-agonists (LABAs) and who experienced one or more severe asthma exacerbation in the previous year (GINA – Global Initiative for Asthma 4-5 step). Tiotropium added to optimal standard of care (SOC) was compared with SOC alone (high-dose inhaled corticosteroid (ICS) and LABA). The Markov model with life-time horizon was constructed on the basis of existing model, from which also transition probabilities were retrieved. It included three asthma controlled states (controlled, partly controlled, uncontrolled), three exacerbation health states (non-severe exacerbation, severe exacerbation, exacerbation with hospitalization) and death. Drug costs (tiotropium, ICS, LABAs), monitoring costs, rescue medication cost and costs of exacerbations (requiring hospitalization and other) were considered. Discount rates of 5% for costs and 3.5% for benefits were used. RESULTS: Tiotropium+SOC generated 13.616 quality adjusted life years in the life-time horizon, whereas SOC was associated with 13.367 QALY. The incremental cost-effectiveness ratio (ICER) of tiotropium+SOC vs SOC alone was estimated to be €16,137/QALY from the public payer’s perspective. The ICER from common (patient+NHF) perspective amounted to be €23,923/QALY. Both results were below the cost-effectiveness threshold accepted for Poland (€27,275/QALY). CONCLUSIONS: Treatment of uncontrolled severe asthma with tiotropium delivered via Respimat added to high-dose inhaled corticosteroid and LABA is a cost-effective strategy in comparison to optimal SOC from both perspectives considered. The assessed technology is a response for existing unmet medical need in Poland.