My advice for FWIW is to buy a reasonablby priced 4th axis direct drive or belt drive type, the worm and wheel type wear very quickly unless you pay big money for a high quality one. I have a Sherline one on a Triac and it really isn`t very good, when I get the chance/time to get back into my workshop I will be doing a Servo driven either belt or direct driven one !!
On the belt type, nothing wrong with that at all, remember your X,Y and Z axis are already running with belts and the backlash is minimal, there is usually more in the ballscrews

Direct drive speaks for itself, no issues with either belts or worms so if you have the space for one, remember it may foul your enclosure if you have one.
Now, as Mach3/4 is outputting a step/direction signal you can fit a small say 100watt or 200Watt Servo motor instead of a Stepper depending on how hard you want to machine on your 4th axis, the reason for this is that you can buy Servo motors that have a Brake built in so when the axis stops the Brake is applied which gives a much more stable and accurate position to machine against

Downside of the Servo with Brake is you may need an extra small power supply for the Servo Drive as it will be different to your Stepper drives PSU and also a small low voltage supply for the Brake, usually 24volts DC on the Brake.
You will need to get all the relevant dimensions and double check just how far the motor with Brake will stick out, they are quite a bit longer than a normal servo and way longer than a Stepper
Just my ideas on this and from what I have researched it isn`t terribly expensive, not cheap but not going to break the average bank
Hope that helps.
Regards
Rob