OBJECTIVES: To assess the efficiency of two surgical procedures for the treatment of female Stress Urinary Incontinence (SUI): Tension-Free Vaginal Tape (TVT) and Open Burch Colposuspension (OBC), through an economic evaluation. METHODS: A cost-minimization model was undertaken as evidence from randomized controlled clinical trials show there are no statistically significant differences between efficacy rates of both procedures in the short and medium term. The model was carried out from the public payer's perspective (National Health System) with a time horizon of 3 months. The resource use and costs with each procedure were compared in terms of pre-surgical resources, the surgical intervention itself, hospitalization, post-surgical follow-up and management of complications. Outcomes of the model were the average cost per patient and the incremental cost (additional cost or savings) between the two procedures. Resource use data was collected from a panel of 7 clinical opinion leaders specialized in female SUI (3 urologists and 4 gynaecologists). All unit costs were retrieved from published sources and refer to 2002 Euros. Sensitivity analyses were performed for key parameters of the model. RESULTS: In the base case, the overall average cost per patient was €1680.56 and €3015.86 with the TVT and OBC respectively. Incremental cost per patient was €-1335.30, the largest difference was due to the length of hospital stay (€-1468.50). The surgical procedure was the only item that resulted in more resource consumption in the TVT procedure (differential cost per patient of €158.29). Sensitivity analyses showed that even in the case where the TVT patients are hospitalized for 3 days, the TVT procedure remains the least resource consuming and the least costly option (differential cost per patient of €-513.80). CONCLUSIONS: The TVT procedure proved to be more efficient than the OBC option in the surgical treatment of female SUI.