Objective To compare the procedures of Burch retropubic urethropexy, modified Pereyra, and anterior colporrhaphy from a cost-effectiveness viewpoint. Study Design A literature search identified prospective and retrospective studies reporting objective cure rates of genuine stress incontinence at 1 and 5 years after operation. Hospital costs were estimated based on reimbursements from third-party payers in the region. Cost-effectiveness for each procedure was calculated, defined as the cost per cure at 1 and 5 years after operation. Results The cost of a Burch retropubic urethropexy was greater than either the modified Pereyra procedure or anterior colporrhaphy. Using baseline estimates for costs and effectiveness from prospective, randomized studies, Burch retropubic urethropexy is more cost-effective than the modified Pereyra procedure or anterior colporrhaphy at 1 and 5 years after operation. Conclusions The greater effectiveness of Burch retropubic urethropexy at 5 years after operation yields a lower cost-per-objective cure of genuine stress incontinence. © 1997 Lippincott Williams & Wilkins, Inc.