OBJECTIVES: Overactive bladder is a dysfunction of the lower urinary tract which causes significant impairment to patients’ quality of life and affects a relatively large portion of the population.  Patients who have failed all conservative treatment options are faced with managing their incontinence symptoms through the daily use of incontinence pads, or their retention by frequent clean intermittent self catheterization.  Patients with severe symptoms may be offered a highly invasive surgical procedure, such as myectomy, urinary diversion or bladder augmentation but these are all associated with serious complications and morbidity.  The objective is to assess cost-effectiveness of sacral neuromodulation as a second line treatment option for patients with OAB in the Dutch setting. METHODS: An economic model comparing sacral neuromodulation with optimal medical treatment was developed. Health states were  defined in terms of ‘cure’ defined as no incontinence or a clinical improvement > 90%, or ‘improvement’ defined as 50% or greater reduction in main continence or urgency frequency symptoms. Associated clinical effectiveness and utility values were taken from published international clinical studies, and treatment costs were based on national sources. Analyses from the healthcare payer’s perspective were performed for a 10 year time-horizon.   RESULTS: The results of the deterministic cost-effectiveness analysis showed that sacral neuromodulation provides an additional 1.53 QALY’s against extra cost of €8222 per patient over a 10 year period.  The corresponding cost-effectiveness ratio was €5732 per QALY gained. Probabilistic sensitivity analysis showed the robustness of these results.CONCLUSIONS: Use of sacral neuromodulation as a treatment option for patients with OAB in the Netherlands will improve patients’ outcomes at a reasonable cost.