Abstract Objective To assess the cost‐effectiveness of app‐based treatment for female stress, urgency or mixed urinary incontinence (UI) compared with care‐as‐usual in Dutch primary care. Design A pragmatic, randomised controlled, superiority trial. Setting Primary care in the Netherlands from 2015 to 2018, follow‐up at 12 months. Population Women with ≥2 UI‐episodes per week, access to mobile apps, wanting treatment. Methods The standalone app included conservative management for UI with motivation aids (e.g. reminders). Care‐as‐usual delivered according to the Dutch GP guideline for UI. Main outcome measures Costs and cost‐effectiveness and ‐utility were assessed from a societal perspective, based on incontinence impact adjusted life years (IIALYs), quality adjusted life years (QALYs) and medical, non‐medical and productivity costs. Information on costs was obtained with the iMCQ and iPCQ questionnaires (medical consumption and productivity cost questionnaires). Results In all, 262 women were andomised equally to app or care‐as‐usual; 89 (68%) and 83 (63%) attended follow‐up, respectively. Costs were lower for app‐based treatment with € −161 (95% confidence interval [CI −180 to −151) per year. Cost‐effectiveness showed small mean differences in effect for IIALY (0.04) and QALY (−0.03) and thus larger incremental cost‐effectiveness ratios (ICER: −€3696) and incremental cost‐utility ratios (ICUR: €6379). Conclusion App‐based treatment is a cost‐effective alternative to care‐as‐usual for women with UI in Dutch primary care. Tweetable abstract App‐treatment for female urinary incontinence cost‐effective compared to care‐as‐usual in general practice after 12 months.