Objective: The aim of the study was to compare 2 diagnostic tests for genuine stress incontinence, cough stress test with simple cystometrogram (CST/CMG) and multi-channel urodynamics (MCU), from a cost-effectiveness standpoint. Methods: The perspective of a health care planner with constrained resources was taken. The literature was accessed for relevant studies detailing the costs and effectiveness of the 2 diagnostic tests. Charges were used as an index of costs; sensitivity was used as the most relevant index of effectiveness. Baseline values of costs and effectiveness were the calculated means for all reported values; plausible ranges from the relevant studies were used in sensitivity analyses. The costs associated with performing the tests were considered; equipment costs were not included. Results: Using incremental cost-effectiveness analysis and baseline values, compared with a no-testing policy, the cost per diagnosis of CST/CMG was $249 (1998, United States dollars). Compared with CST/CMG, the incremental cost per diagnosis of MCU was $16,550. Sensitivity analyses of costs and effectiveness strengthened these conclusions. Conclusion: From the perspective of the health care planner, CST/CMG is more cost-effective than MCU in diagnosing genuine stress incontinence, particularly in patients with the symptom of pure stress incontinence. Patients with complex histories, underlying neurological disease, or symptoms of mixed incontinence may benefit from multichannel urodynamics.