OBJECTIVES: To determine the cost-effectiveness of pharmacologic treatments for overactive bladder. METHODS: A decision model was constructed based on studies of effectiveness, adverse consequences, comorbid conditions, and medical costs for the treatment of overactive bladder. The model was based on a previously published cost-effectiveness model. The  3 month model classifies patients to 1 of three states after treatments including: 1) complete continence; 2) treatment failure; and 3) discontinuation of treatment.  Estimates of complete continence were obtained from trials involving products on the US market as of February 2011.  These products included darifenacin, fesoterodine, oxybutynin immediate release (IR), oxybutynin extended release (ER), oxybutynin topical gel, oxybutynin transdermal patch, solifenacin, tolterodine IR, tolterodine ER, trospium IR, and trospium ER.   A systematic search of MEDLINE and Embase was conducted to identify relevant studies.  Costs were derived from the literature and updated to 2011 values using the medical components of the consumer price index.  Medication costs were based on wholesale acquisition cost.  Probabilistic sensitivity analysis was conducted using a Monte Carlo simulation. RESULTS: A total of 51 studies were identified, of which 11 studies reported complete continence rates.  Complete continence rates ranged from 19.0% for darifenacin to 51.0% for solifenacin.  The lowest cost treatment was oxybutynin IR ($752 per patient) and the highest cost was trospium IR ($1,223 per patient).  The product with the lowest ICER relative to oxybutynin was solifenacin at $1,405 per additional continent patient. The cost-effectiveness acceptability curve indicated oxybutynin IR was most cost-effective with willingness-to-pay (WTP) values less than $10,000, and solifenacin was most cost-effective at higher WTP values.   CONCLUSIONS: Compared with generic oxybutynin IR, only solifenacin was more cost-effective and had an ICER below $1,500 per successfully treated patient.  Only oxybutynin IR and solifenacin had a non-zero probability of being cost-effective as compared to other therapies.