OBJECTIVES: Hyperactive Bladder (HB) is a common, debilitating condition with a considerable negative impact on quality of life. The cost-effectiveness (CE) of three medications was evaluated for the treatment of patients with Hyperactive Bladder from the Mexican Institute of Social Security (IMSS) perspective. METHODS: CE analysis from the perspective of the service provider (IMSS). Since it is a chronic disease with different stages, a Markov model with monthly cycles in a 12-month temporal horizon was developed.  Only direct medical costs were used in the analysis. Direct medical costs were estimated on a sample of patient files in two IMSS medical units. Criteria for inclusion was patients with more than 6 months of treatment. The effectiveness measurement was taken from literature and was defined as the percentage of patients that did not present symptoms of incontinence. Univariated and probabilistic sensitivity analyses were performed. RESULTS: The oxybutynin treatment reflected the lowest expected cost per patient treated for hyperactive bladder, US$545 (1 USD= 13.5MXN); followed by the solifenacin and tolterodine treatments, with a cost of US$680 and US$1,135, respectively. As for the effectiveness measurement, the percentage of patients that did not present incontinence within the temporal horizon of analysis was: with tolterodine 2.76%, with oxybutynin 7.11% and with solifenacin 7.46%. Therefore, cost effectiveness ratios interpreted as the cost per percentage point of patients that did not present HB are: oxybuynin US$77, solifenacin US$91 and tolterodine US$411. The incremental cost effectiveness analysis indicates that tolterodine is a dominated alternative and that oxybutynin and solifenacin are positioned within the efficiency line. Nonetheless, when conducting the probabilistic analysis, it was found that with US$411 available, a solifenacin treatment would be more cost effective for the institution.   CONCLUSIONS: From an institutional perspective, solifenacine is a cost-effective alternative for treating patients with HB in the Mexican context.