OBJECTIVES:  In the FLAME study indacaterol (110 µg) plus glycopyrronium (50 µg) (IND/GLY) reduced the annual rate of exacerbations (11% reduction all exacerbations, p=0.003) over Salmeterol/Fluticasone (SFC) in patients with COPD and a history of exacerbations during the previous year. The evidence generated advocates that dual bronchodilation (IND/GLY) can improve treatment outcomes nevertheless there is limited information on the impact associated to health resource utilization and costs. Quantify treatment outcomes, resource utilization and budget impact associated with the use of IND/GLY and SFC in the treatment of Portuguese patients with COPD. METHODS:  A cost-consequence analysis was undertaken using the FLAME study data to estimate treatment outcomes and economic impact associated to IND/GLY and SFC in COPD patients with a history of exacerbations. Primary outcomes of interest are COPD exacerbations (total, moderate and severe) and direct medial costs. Treatment outcomes and costs were estimated for a 52 weeks’ time horizon and only direct costs were considered. Portuguese data was used to identify the target population, health resource utilization and unit costs. RESULTS:  Treatment with indacaterol–glycopyrronium can result in fewer exacerbations (35.9 exacerbations IND/GLY vs. 40.3 exacerbations SFC for every 10 patients treated) and lower costs (€18,872 for IND/GLY vs. €20,040 for SFC for every 10 patients treated). It is estimated that currently there are 10,259 COPD patients with a history of exacerbations and treated with SFC. If treated with QVA149 it is estimated that these patients could experience 4,514 fewer exacerbations with a reduced overall treatment cost of €1,198,240 after 52 weeks of treatment. CONCLUSIONS:  The analysis suggest that IND/GLY can provide better treatment outcomes with fewer treatment costs for the Portuguese NHS when compared to SFC in the treatment of Portuguese COPD patients with a history of exacerbations.