OBJECTIVES: To examine the economic burden and health care utilizations of patients diagnosed with pancreatic cancer in the U.S. veteran population.  METHODS: A retrospective database analysis was performed using Veterans Health Administration Medical SAS data from 01OCT2007 through 30SEP2012. Patients diagnosed with pancreatic cancer were identified using International Classification of Disease 9^th Revision Clinical Modification (ICD-9-CM) code 157. The first diagnosis date was defined as the index date. A group of patients with similar age, region, gender and index year but without a pancreatic cancer diagnosis were identified as the comparison group and matched by baseline Charlson Comorbidity Index scores. One year of continuous health plan enrollment was required before and after the index date for both groups. Study outcomes, including health care costs and utilizations, were compared between pancreatic cancer and comparator groups using 1:1 propensity score matching (PSM).  RESULTS: A total of 10,894 patients were identified for the pancreatic cancer and comparison cohorts. After applying a 1:1 PSM, 3,671 patients were matched from each cohort, and the baseline characteristics were proportionate. Pancreatic cancer patients were more likely to have higher health care resource utilizations, including inpatient admissions (38.03% vs. 2.18%, p<0.0001), emergency room (ER) (30.67% vs. 5.48%, p<0.0001), physician office visits (98.39% vs. 57.91%, p<0.0001) and prescription fills (83.55% vs. 62.82%, p<0.0001). Risk-adjusted health care costs were also higher for pancreatic cancer patients, including inpatient ($18,079 vs. $442, p<0.0001), ER ($330 vs. $46, p<0.0001), physician office ($5,600 vs. $1,106, p<0.0001) and pharmacy costs ($2,244 vs. $321, p<0.0001), resulting in higher total costs ($26,503 vs. $1,977, p<0.0001) relative to the comparator cohort.  CONCLUSIONS: During a period of 12 months, VHA patients diagnosed with pancreatic cancer reported higher health care resource utilization and costs than their matched controls.