OBJECTIVE: To compare the cost-effectiveness (CE) of three competitive surgical procedures for female stress urinary incontinence (SUI). The three procedures are retropubic urethral suspension (Burch), urethral sling, and a new procedure using SURx technology. The study population consists of women aged 18 to 85 years who have a confirmed diagnosis of type I or type II genuine SUI and a planned surgical treatment procedure. The perspective of commercial third-party payers is taken for this study. METHODS: A decision model was developed to compare the costs and effectiveness of the three treatment strategies for SUI. A hypothetical woman in the study population is treated with one of the three treatment alternatives and tracked over a period of 12 months. The CE ratio was defined as cost per cure. Only direct medical costs were included and estimated by charge data (in year 2000 dollars). The costs, effectiveness, and outcome probabilities were collected from InPatientView, the HCUP Nationwide Inpatient Sample, HCCA Physician Fee & Coding Guide, the literature, SURx clinical trials, and experts' suggestions. RESULTS: The SURx procedure has the lowest costs ($11,757.22) and the highest effectiveness (0.94). The CE of the SURx, Burch, and Sling procedures was $12,539.70, $13,167.85, and $13,736.07 per cure, respectively. Burch and Sling procedures were dominated by SURx treatment. The incremental CE of Sling was $52,310.61 per additional cure relative to Burch. The CE ratio was sensitive to the hospital and physician costs of each procedure and the SURx cure rate. The threshold value of the SURx cure rate was 62%. CONCLUSIONS: SURx technology for treatment of women with type I or II genuine SUI is the most cost-effective treatment option as compared to the Burch and Sling procedures. Therefore, SURx may be an appropriate first-line therapy for SUI.