Sanjay Sethi,1 Antony Wright,2 Elisabeth Sophia Hartgers-Gubbels,3 Marlene Hechtner,3 Brendan Clark,4 Ciara Wright,2 Sue Langham,2 Roland Buhl5 1Pulmonary/Critical Care/Sleep Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA; 2Maverex Ltd., Newcastle Upon Tyne, NE6 2HL, UK; 3Boehringer Ingelheim GmbH, Ingelheim Am Rhein, Germany; 4Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA; 5Pulmonary Department, Mainz University Hospital, Mainz, GermanyCorrespondence: Antony Wright, Maverex Ltd, Newcastle Upon Tyne, NE6 2HL, UK, Tel +44 (0) 161 4646838, Email antonywright@maverex.comPurpose: The objective of this study was to assess the clinical and cost benefits of treating patients with chronic obstructive pulmonary disease (COPD) according to global and national guidelines compared to real-life clinical practice in the United States and three European countries (Belgium, Germany, Sweden).Patients and Methods: A cost-consequence model was developed to compare current prescribing patterns with two alternative scenarios, the first aligned with the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2022) recommendations and the second with national guidelines. Costs and clinical outcomes were modeled for these alternative scenarios over a time horizon of one year, based on real-world evidence and health insurance data.Results: Current clinical practice in each of the countries was inconsistent with published recommendations. A redistribution to prescribing patterns according to global and national recommendations led to a substantial decrease in the use of inhaled corticosteroid (ICS) containing therapies of more than 80% and 44%, respectively. There was a reduced incidence of up to 16% of mild-to-moderate pneumonia and up to 29% of severe pneumonia. Exacerbations decreased across all countries apart from Sweden, where a small increase in the rate of exacerbations was due to the redistribution of some patients currently undergoing inhaled triple therapy to ...