OBJECTIVES: To conduct cost-effectiveness and cost-utility analyses of a model of treatment for urge incontinence in community-dwelling older adults. METHODS: A decision-analytic, cost effectiveness/utility model was constructed in TreeAge pro 2009 that examined three treatment pathways starting withlimited behavioral therapy (LBT), full behavioral therapy (FBT) or drug (DRUG) treatment with each followed by possible crossover to or adding an alternative therapy based on treatment results. RESULTS:   All strategies compared to no treatment prevented incontinence episodes and generated additional QALYs. Compared to no treatment, the costs per QALY gained ranged from $2850 to $7276.  At baseline values, LBT was the least costly, but produced the least benefit.  DRUG was the most expensive and produced less benefit than FBT. Only small changes in withdrawal rates and baseline effectiveness were required for DRUG to generate greater gains than FBT.  The incremental cost of moving from the lowest cost strategy to FBT with the greatest gain was $507 per additional QALY gained. CONCLUSIONS:   All treatment strategies examined for urge incontinence provide clinical benefits, are relatively cost effective and offer QALYs at a bargain price. Clinicians should be encouraged to screen for and actively offer treatment options for urge incontinence in older adults.