OBJECTIVES: This study compared healthcare resource utilization (HRU) and costs among children/adolescents with attention deficit/hyperactivity disorder (ADHD) in Germany who initiated treatment with atomoxetine (ATX) or long-acting methylphenidate (LA-MPH). METHODS: A retrospective propensity score matched cohort analysis was conducted using the IMS electronic medical record database comprising >15 million patient records from ~3,000 German physicians. Included patients were aged 6-17 years, with a first (index) ATX or LA-MPH prescription in 2006-2010; ≥1 ADHD diagnoses 12-month before (pre-index) and after (post-index) index; and ≥1 index medication prescription post-index. Patients in the ATX and LA-MPH cohorts were matched 1:1 using “nearest neighbor” greedy match propensity score method. HRU (inpatient, outpatient, and medications) and costs were compared between the two cohorts. Unit costs were identified from German Diagnosis-related Group for inpatient, Einheitlicher Bewertungsmassstab doctor fee scale for outpatient, and Rote Liste®for medication costs. Direct medical costs over the post-index period were reported in 2011 Euros. Chi-square for categorical variables and t-test or Wilcoxon-Mann-Whitney for continuous variables were used to test for differences between cohorts (alpha=0.05). Generalized linear models with negative binomial (for HRU) and gamma (for cost) distributions were used to address residual differences between matched cohorts. RESULTS: Of 4,705 eligible patients, 737 with ATX (mean age=10.9 years, 20.8% female) were identified and matched 1:1 with LA-MPH patients (mean age=11.2 years, 18.6% female). Patients initiating ATX had higher HRU and spending per-patient than patients initiating LA-MPH over the post-index: 20.9 (SD=11.5) vs. 15.7 (SD=9.0) outpatient prescriptions, 10.1 (SD=6.3) vs. 8.3 (SD=5.3) outpatient visits, €1029 (SD=574) vs. €496 (SD=334) in retail pharmacy costs, and €1,258 (SD=739) vs. €684 (SD=515) in total all-cause costs (all p=<.0001). CONCLUSIONS: Among children/adolescents with ADHD in Germany, ATX initiators consumed significantly more healthcare resources and were associated with significantly higher direct medical costs compared with LA-MPH initiators.