OBJECTIVES: To assess the economic value of fesoterodine compared to tolterodine for the treatment of overactive bladder (OAB) with urgency urinary incontinence (UUI) in Spain and Finland. METHODS: A decision-tree economic model estimated the 52-week costs and quality-adjusted life years (QALYs) of OAB/UUI patients initiating treatment with fesoterodine 4mg/day or extended-release (ER) tolterodine. Treatment response (UUI <1 episode/day) and persistence were evaluated at weeks 4, 12, and 24.  Titration from fesoterodine 4mg/day to 8mg/day was permitted at week 4. At week 12, non-responders discontinued treatment permanently. Efficacy, discontinuation, and utility data were derived from four clinical trials of fesoterodine. OAB-related costs including physician visits, laboratory tests, incontinence pads, and comorbidities (fracture, skin infection, urinary tract infections, depression, and nursing home) were also included.  The perspective was that of the National Health Systems (2012€). Uncertainty surrounding the model parameters was assessed by univariate and probabilistic sensitivity analysis (PSA). RESULTS: 19.5% and 18.0% of fesoterodine and ER tolterodine patients remained on treatment until week 52, respectively. QALYs were higher with fesoterodine than tolterodine (0.762 vs. 0.760).  In Spain, fesoterodine treatment had higher costs than (generic) ER tolterodine (€6 697 vs. €6 597), resulting in a cost of €15 600/QALY gained. In Finland, fesoterodine was cost-saving relative to (non-generic) ER tolterodine (€7 885 vs. €8 024). Sensitivity analysis confirmed these findings were robust to the expected price decrease for generic ER tolterodine in Finland. In the PSA, fesoterodine was consistently the preferred therapy in Finland regardless of the value of a QALY and in Spain for QALY valuations greater than €15 000. CONCLUSIONS: Fesoterodine is cost-effective or cost-saving relative to ER tolterodine for the treatment of OAB with UUI in two European countries. Payers and prescribers should consider a broad scope of costs in order to make informed cost-conscious choices of antimuscarinic treatment.