To the Editor: The recent paper by Pelling et al suggests that sacral neuromodulation (SNM) is the most cost-effective thirdline treatment option for overactive bladder at 15 years. 1 This may or may not be true. However, their analysis is deeply flawed due to the information about SNM costs they have input into their model. They suggest that based on the Merative MarketScan Commercial and Merative MarketScan Medicare supplemental databases, the average all-inclusive costs of placement of an SNM device (I presume this includes a lead, an implantable generator, professional fees, and operating room costs) are $5179.10 and $6099.00, respectively. Frankly, these numbers are mind-boggling. I suspect anyone who implants SNM devices would agree. There is no way that any health care organization in the US is able to obtain even the device for that price. At a minimum, the cost of just the deviceda lead and implantable generatordis at least $15,000. In fact, a recent study published in the Journal of Comparative Research Effectiveness