OBJECTIVES: Overactive bladder (OAB) disease with urinary incontinence is a prevalent disorder among millions of women reaping both high burdens in treatment costs and in health-related quality of life. Oxybutynin ER and tolterodine ER are two anticholinergic therapies that have demonstrated efficacy, but have significant adverse event profiles contributing to long-term discontinuation. No current cost-effectiveness analysis has compared these two therapies to the recent release of an additional anticholinergic medication, fesoterodine. With three drugs and numerous possible drug regimens involving switching between medications, there exists need for economic analysis of the costs and QALYs for OAB treatment. The objective of this study was to conduct CE analysis using a backwards induction model to compare costs and quality-adjusted life years (QALYs) for the following drug regimens: oxybutynin ER, tolterodine ER, fesoterodine, oxybutynin switch tolterodine, tolterodine switch oxybutynin, and fesoterodine switch tolterodine. METHODS: The CE model costs were derived using a societal perspective. The analysis was conducted in women with OAB over the age of 45 years old experiencing urinary incontinence and used valued literature sources of clinical, cost and compliance data. RESULTS: Based on the model inputs, the ICER comparing fesoterodine to tolterodine is $65,880/QALY indicating that at the current branded price and base case data on clinical effectiveness and compliance, fesoterodine is the most cost-effective treatment. Sensitivity and threshold analysis indicate that these results are sensitive to changes in the following inputs: utility values for adverse events and medication discontinuation rates. With changes in these values of 15% and 25 % respectively, tolterodine ER is the most cost-effective treatment. CONCLUSIONS: Drug treatment for OAB with urinary incontinence in this population with fesoterodine is most cost-effective when compared to other anticholingerics and switching regimens. Limitations of this study include data on compliance and utility values, which the model is sensitive to.