OBJECTIVES: Rheumatoid Arthritis (RA) patient registries that follow up patients who are on anti-TNF medication provide a rich source of data to evaluate costs and effectiveness of these treatments in real world practice. The study aims to assess the impact of anti-TNF as compared with standard DMARDs on healthcare utilization and costs in an inception patient cohort with RA in Alberta METHODS: The Alberta Rheumatoid Arthritis Biologics Study Database includes patients treated with either standard DMARDs or one of three available anti-TNFs and followed for up to 3 years. Provincial administrative databases between 1.4.2004 and 31.3.2009 were analyzed to identify physician visits, emergency room (ER) and other ambulatory visits, hospitalizations, and costs. A propensity score matching technique was used to compare these outcomes in the first anti-TNF-only to DMARD-only, DMARD switch to anti-TNF, or anti-TNF switch to another anti-TNF groups, and bootstrap method was used to estimate 95% confidence intervals of the differences. 2008 Alberta costs of health services were used for analysis RESULTS: Of 1,222 patients in the database, 1,087 had at least 3 months of administrative data.  The average annual number of visits and costs for the first anti-TNF-only group were for physician services (19.1; $1,568), emergency room (6.7; $1,378), and hospitalizations (0.22; $1,983), with the total annual per patient cost being $4,929. Compared to this group, the costs and utilizations in the anti-TNF switching to another anti-TNF were significantly higher (except hospital costs). However, the DMARD groups’ higher utilization and cost estimates were not statistically significant CONCLUSIONS: Staying on the first anti-TNF reduces significantly the utilization and cost of health services compared to patients switching anti-TNF medication. Due to small samples the comparison to patients starting DMARD medication did not show significant differences