OBJECTIVES: The purpose of this study was to estimate the cost-effectiveness of two therapeutic strategies starting either with Sacral Neuromodulation (SNM) or Botulinum Neurotoxin A (BTX-A) in the treatment of overactive bladder (OAB) wet in Italy. METHODS: A 10-year decisional model was developed to assess costs and outcomes (Quality-Adjusted Life Years – QALYs – gained) associated with the two pathways from the perspective of the Italian National Healthcare System (INHS). Clinical inputs were derived from the literature review and validated by key clinicians in Italy. Unit costs were derived from public sources. Costs for hospital procedures and inpatient stay were derived from one of the centres involved in the study to reflect real costs incurred for SNM implant. Univariate sensitivity analyses (DSA) were conducted to determine whether results were insensitive to variations in uncertain parameters. Probabilistic sensitivity analyses (PSA) were performed to derive cost-effectiveness acceptability curves. RESULTS: Preliminary results showed that at 10 years SNM is a cost-effective strategy. Cumulative costs were €33,897 and €33,572 while cumulative QALYs were 7.55 and 6.80 for SNM and BTX-A respectively. A 4% decrease of incontinence episodes was also observed for SNM compared with BTX-A. DSA demonstrated the robustness of the results. PSA results suggested that 99.9% of the 1000 Monte Carlo iterations fell within a €30,000 cost-effectiveness threshold considered acceptable for a marginal unit of effectiveness. CONCLUSIONS: A therapeutic strategy starting with SNM compared to one starting with BTX for patients with idiopathic OAB-wet is cost-effective for the Italian INHS.