OBJECTIVES: Urgency urinary incontinence (UUI) has a substantial impact on patients' QOL and well-being, and may pose a substantial economic burden on patients and health insurers. We assessed the cost and cost-effectiveness of four conservative treatment modalities for UUI in Israel.   METHODS: 164 women were randomly allocated to one of four interventions: drug therapy (DT), bladder training (BT), pelvic floor muscle-training (PFMT), and combined pelvic floor rehabilitation (CPFR) and were followed over a period of 12-months. Resource utilization including physician encounters, dispensed prescriptions, physical therapist treatment and any other medical services was estimated for each study participant. We also estimated the women's self-reported utilizations of pads, laundry and new underwear. Total costs were calculated by multiplying the volumes of resource utilization by the corresponding unit-prices. We used the bootstrap method to report bias-corrected confidence-intervals of cost estimates. Utility weights were elicited using the EQ-5D questionnaire at baseline, 3-months and 12-months of follow-up. RESULTS: Women in all four treatment groups showed improvements in QOL from baseline to 12-months (DT:0.87 to 0.93, BT:0.85 to 0.89, PFMT:0.82 to 0.84, CPFR: 0.82 to 0.86). Changes in QOL summary scores from study enrollment and end of follow-up were estimated after correction for potential baseline differences, and were not statistically different among study groups. The mean total cost was somewhat lower for the DT group participants ($1,460), as compared with the three other interventions (range: $1,760-$1,990). These differences, however, were not statistically significant. The mean monthly personal costs were significantly reduced from baseline to 12-months of follow-up in all treatment groups.   CONCLUSIONS: The four treatment modalities for treating UUI were equally effective and associated with comparable costs. Therefore, an incremental cost-effectiveness ratio was calculated. Due to the possibility of declining adherence to drug therapy over time, pelvic floor physical therapy can be considered as the first line treatment for UUI.