OBJECTIVES: To compare healthcare costs and utilizations between patients with anxiety versus those without in the U.S. veteran population. METHODS: A retrospective database analysis was performed using the Veterans Health Administration (VHA) Medical SAS datasets (01OCT2008-30SEP2012).  Patients diagnosed with anxiety were identified (ICD-9-CM: 300.xx) from October 01, 2009 through September 30, 2011. The first diagnosis date was designated as the index date for the anxiety group. A group of non-anxiety patients of the same age, region, gender and index year were identified and matched by baseline Charlson Comorbidity Index (CCI) as the comparison group. The index date for the comparator group was randomly chosen to reduce the selection bias. Patients in both groups were required to be at least 18 years old, and have continuous medical and pharmacy benefits 1 year before and 1 year after the index date. One-to-one propensity score matching was applied to compare the healthcare costs and utilizations during the follow-up period between the anxiety and comparison groups, adjusted for baseline demographic and clinical characteristics. RESULTS: A total of 928,724 patients were identified for the anxiety and comparison cohorts. After 1:1 matching, 338,373 of patients were matched from each group and the baseline characteristics were well-balanced. Patients with anxiety had higher percentages of inpatient (11.03% vs. 2.74%, p<0.01), emergency room (18.64% vs. 7.50%, p<0.01), physician office (99.53% vs. 59.16%, p<0.01), outpatient (99.68% vs. 59.91, p<0.01) and pharmacy visits (91.42% vs. 59.13%, p<0.01). The anxiety group had higher expenditures in inpatient ($3,347 vs. $782, p<0.01), emergency room ($204 vs. $68, p<0.01), physician office ($3,527 vs. $1,435, p<0.01), outpatient ($3,948 vs. $1,621) and pharmacy visits ($745 vs. $429, p<0.01) than the comparison group. CONCLUSIONS: Results suggest that patients diagnosed with anxiety used significantly more healthcare resources and incurred significantly higher healthcare costs compared to patients without.