OBJECTIVE: To estimate costs of routine care for female urinary incontinence, health-related quality of life, and willingness to pay for incontinence improvement. METHODS: In a cross-sectional study at 5 U.S. sites, 293 incontinent women quantified supplies, laundry, and dry cleaning specifically for incontinence. Costs were calculated by multiplying resources used by national resource costs and presented in 2005 United States dollars ($2005). Health-related quality of life was estimated with the Health Utilities Index. Participants estimated willingness to pay for 25-100% improvement in incontinence. Potential predictors of these outcomes were examined using multivariable linear regression. RESULTS: Mean age was 56 ± 11 years; participants were racially diverse and had a broad range of incontinence severity. Nearly 90% reported incontinence-related costs. Median weekly cost (25%, 75% interquartile range) increased from $0.37 ($0, 4) for slight to $10.98 ($4, 21) for very severe incontinence. Costs increased with incontinence severity (P < .001). Costs were 2.4-fold higher for African American compared with white women (P < .001) and 65% higher for women with urge compared with those having stress incontinence (P < .001). More frequent incontinence was associated with lower Health Utilities Index score (mean 0.90 ± 0.11 for weekly and 0.81 ± 0.21 for daily incontinence; P = .02). Women were willing to pay a mean of $70 ± $64 per month for complete resolution of incontinence, and willingness to pay increased with income and greater expected benefit. CONCLUSION: Women with severe urinary incontinence pay $900 annually for incontinence routine care, and incontinence is associated with a significant decrement in health-related quality of life. Effective incontinence treatment may decrease costs and improve quality of life. © 2006 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.