OBJECTIVES: To apply the stratified propensity score matching technique to estimate the healthcare costs of rheumatoid arthritis (RA) patients. METHODS: Continuously eligible adult patients with confirmed diagnoses of RA between June 2004 and June 2009 were included in the study.  Patients were either new to tumor necrosis factor (TNF) therapy and subsequently switched to another anti-TNF, or escalated their TNF dose. The difference in total and RA-related healthcare costs between switchers and escalators 1 year after the switch/dose escalation were estimated using the stratified propensity score matching method with five subclasses. The differences in patient, clinical, and demographic characteristics were controlled as well. RESULTS: After risk adjustment using stratified propensity score matching, the difference between switchers and dose escalators is $2,905 in total healthcare costs, $8,577 in outpatient costs, $630 in inpatient costs, $10,851 in pharmacy costs, $2,294 in RA-related healthcare costs, $8,410 in RA-related outpatient costs, $36 in RA-related inpatient costs, and $10,668 in RA-related pharmacy costs. CONCLUSIONS:  After adjusting for patient, clinical and demographic characteristics using the stratified propensity score matching method, patients who switched to another anti-TNF incurred more total and RA-related healthcare costs compared to patients who escalated their dose. The cost burden is mainly attributed to pharmacy costs.