OBJECTIVES: To describe the association between serum uric acid (sUA) levels and gout-related healthcare utilization and costs. METHODS: A retrospective analysis was conducted using a database from a regional managed care organization. Patients with primary gout were included in the study if they met the following criteria between 2006 and 2007: (1) age ≥18; (2) ≥1 diagnosis of gout (ICD-9-CM 274.xx), or ≥1 prescription gout-related medications (colchicine, allopurinol, probenecid); (3) 12 months continuous eligibility pre- and post- either the first gout diagnosis or first pharmacy claim date (index date). Patients with cancer diagnoses were excluded. Patients were classified into three sUA levels based on the measurement taken on the date closest to the index date: <6.0 mg/dL, 6.0- 8.99 mg/dL, and ≥9.0 mg/dL. Healthcare costs in the12 months post index period were compared across the three sUA levels using Kruskal-Wallis tests. RESULTS: A total of 1,622 patients were identified; 374 (23.0%) had an sUA <6.0 mg/dL, 788 (48.0%) had an sUA of 6.0-8.99 mg/dL, and 470 (29.0%) had an sUA ≥9.0 mg/dL. The mean gout-related healthcare costs were $217(standard deviation [SD] $631), $426 (SD $4330), and $647(SD $4274) for patients with sUA <6.0 mg/dL, 6.0- 8.99 mg/dL, and ≥9.0 mg/dL, respectively (p<0.0001). Statistically significant differences were also detected in the gout-related outpatient costs, gout-related emergency department costs, and gout-related prescription costs among the three groups. CONCLUSIONS: Our results showed that there is a positive association between sUA levels and gout-related healthcare utilization and costs. Lowering and maintaining sUA levels <6 mg/dL may lead to lower gout-related healthcare costs and decrease gout-related utilization of services. Further study is warranted.