OBJECTIVES: To compare healthcare resource utilization and costs in OAB adults receiving fesoterodine, solifenacin or tolterodine in clinical practice in Spain. METHODS: A retrospective study was designed using primary care electronic medical records from three towns in Spain. Records of patients who initiated OAB therapy between 2008 and 2010 and with a follow-up of at least 52 weeks were retained. Patients over 18 of both genders with an OAB diagnosis [ICD-9-CM 596.51] and a new prescription of fesoterodine, tolterodine or solifenacin were included in the analyses. All type medical visits (primary care, specialist and emergency room), absorbents for urinary incontinence, complementary/diagnostic tests and concomitant medications related with OAB along with cost of antimuscarinics used were analyzed (NHS perspective). Comparisons between antimuscarinics were adjusted by location, age, sex, time since diagnosis, co-morbidity burden and medication possession ratio (medication/time), and were compared using univariate general linear models with bootstrap (1000 re-samples) bias correcting methods to calculate 95% confidence intervals. RESULTS: A total of 1,971 records (58.3% women, 70.1 [SD: 10.6] years) were analyzed; 302 treated with fesoterodine, 952 with solifenacin and 717 with tolterodine. Respectively, 17%, 22% and 25% of subjects used absorbents during the study (p=0.014).  Adjusted mean healthcare costs (95% bootstrap CI) were significantly lower with fesoterodine treatment [€1639 (1542; 1725)] compared with solifenacin [€1780 (1699; 1854), p=0.022] or tolterodine [€1893 (1815; 1969), p=0.001]. All medical visits costs were also lower with fesoterodine €433 (411; 457) than with solifenacin [€533 (515; 552); p=0.001] or tolterodine [€563 (539; 585), p=0.001]. Drug costs due to co-morbidities associated with OAB were also lower with fesoterodine [€216 (180; 258)] compared with solifenacin [€305 (274; 338); p=0.002] or tolterodine [€335 (306; 366), p=0.001]. CONCLUSIONS: Treatment of OAB with fesoterodine in clinical practice in Spain was a cost-saving therapy from the NHS perspective as compared to solifenacin or tolterodine.