OBJECTIVES: Sacral Nerve Modulation (SNM) is a minimally-invasive technology indicated for overactive bladder (OAB). SNM efficacy has been widely demonstrated yet its cost-effectiveness in the UK is unknown. The cost-effectiveness of SNM in patients with refractory idiopathic OAB with urinary incontinence (OAB-wet) was compared to optimal medical therapy (OMT), Botulinum Toxin A (BoNT-A) and PTNS from the UK NHS perspective. METHODS: A published Spanish Markov model was adapted to current UK practice based on existing data and clinical expert advice. Treatment success was defined as >50% improvement in OAB-wet symptoms. Health care resource use included pre-,peri-, and post-procedure; drugs; follow-ups and adverse events. Both SNM using testing with tined-lead (SNM-tined-lead) and PNE (SNM-PNE) were evaluated. Incremental-cost-effectiveness-ratios (ICER;costs per quality-adjusted-life-year)were calculated for SNM vs. OMT and vs. BoNT-A (10yrs), and SNM vs, PTNS (5yrs); with uni-variate sensitivity analyses. RESULTS: At 10 years, the cumulative costs of SNM-tined-lead, SNM-PNE, BoNT-A and OMT were £22,052, £19,952, £18,477, £11,918, respectively; PTNS 5-year cumulative costs were £17,915.The QALYs for SNM-tined-lead, SNM-PNE, BoNT-A and OMT were 6.82, 6.64, 6.35 and 5.45 (10yrs), respectively, and 3.44 for PTNS (5yrs). ICERs were £7,608 and £7,356 for SNM-tined-lead vs. BoNT-A, and vs OMT (10yrs), respectively; SNM-tined-lead and SNM-PNE were dominant (less costly and more effective) compared to PTNS (5 years). SNM- tined-lead was cost-effective vs.SNM-PNE. ICERs were most sensitive to BoNT-A efficacy and costs, but results were generally robust. CONCLUSIONS: SNM in patients with OAB-wet provides additional quality of life improvement with higher initial costs for SNM that are offset by a reduction in follow-up costs over time. This produces ICERs that are clearly below the threshold generally considered for cost-effectiveness in the UK. SNM represents value for money compared to OMT, BoNT-A and PTNS, and may be considered the preferred treatment option in the UK.