OBJECTIVES: Antimuscarinic agents and mirabegron, a β-adrenoceptor agonist, are widely used to treat the symptoms of OAB. Compared to antimuscarinics, mirabegron has similar efficacy, is associated with better persistence and has a lower incidence of anticholinergic side effects. Through the use of real-world data, this study estimated the costs associated with OAB management in the UK. METHODS: A 1-year economic analysis was performed using a Markov model with monthly cycles. Patients entered the model and initiated treatment with mirabegron, fesoterodine, oxybutynin extended release (ER), oxybutynin intermediate release (IR), solifenacin, tolterodine ER/IR or trospium ER/IR. Patients either persisted on treatment and were controlled, switched to another treatment, had minimally-invasive surgery or were uncontrolled. Model inputs included the proportion of patients with incontinence, 12-month persistence data, the probability of switching treatment and both direct costs (e.g. acquisition costs, resource use) and indirect costs (e.g. loss of working time). A one-way sensitivity analysis determined the influence of persistence and switching on findings. RESULTS: For a cohort of 100 patients, mirabegron treatment resulted in greater persistence compared with antimuscarinics (48.6% vs 23.4–36.0%) and a smaller proportion of patients switched (13.2% vs 16.4–19.7%). Treatment with mirabegron resulted in fewer healthcare visits (282 vs 290–299), reduced pad use (68,632 vs 72,840–77,636) and fewer work hours lost (32.6 vs 42.4–53.5/patient) compared with antimuscarinics. The estimated total annual cost of mirabegron treatment per patient was £1,168.17 (£3.20/day) compared with £1,280.66–1,449.24 (£3.51–3.97/day) for antimuscarinics. Sensitivity analysis confirmed the robustness of the model. CONCLUSIONS: In the UK, superior persistence with mirabegron compared to antimuscarinics is associated with lower resource use, fewer work hours lost, and an overall reduction in total costs. These data suggest that mirabegron provides clinical and economic benefits compared with antimuscarinics in management of OAB from a societal perspective.