OBJECTIVES Anticholinergics drugs (ACHD) are an established first-line pharmacological therapy for overactive bladder (OAB). Despite the fact that many patients cycle through multiple ACHD, there is limited evidence on the relationship between the burden on secondary (hospital) care and these patients whose OAB is inadequately managed with ACHD. The objective of this study was to analyse the variation in healthcare burden in secondary care of patients who cycle through multiple ACHD. METHODS A retrospective observational study was conducted to examine the relationship between healthcare burden and number of prior ACHD with each ACHD switch. Data was extracted from the Hospital Episode Statistics (HES) database and 3,059 GP practices for patients with a diagnosis for OAB, or any of the symptoms of OAB (frequency, urgency, incontinence or nocturia) and with at least one prescription for an ACHD between April 2007 and March 2013. Treatment activity and cost burden (including burden associated with comorbid conditions) were analysed following initiation of the second and the third ACHD and compared to the same cohort from the point at which they had received the first ACHD. All costs were calculated by applying national health service (NHS) tariff prices to treatment activity. RESULTS Overall, the number of patients identified was 13,117. Our analysis showed that there were increases of 70%, 40% and 10% in inpatient, outpatient and emergency settings respectively from the initial ACHD prescription to 3+ ACHD. This led to an increase in overall healthcare costs of 30% from the first to 3+ ACHD or £197 (£642 to £839) per patient over the investigation period. CONCLUSIONS OAB patients who are inadequately managed with ACHD place an increased burden on hospital resources. These findings emphasize the importance of identifying alternative ways to treat these patients to address the cumulative burden they place on healthcare systems.