OBJECTIVES: To compare medical care consumption between duloxetine initiators and pregabalin initiators among fibromyalgia patients. METHODS: We conducted a retrospective cohort study based on a US national commercial claims database (2006~2009).  Fibromyalgia patients who initiated duloxetine or pregabalin in 2008, age 18 to 64, and maintained continuous health insurance coverage one year before and one year after initiation were assigned to duloxetine or pregabalin cohorts based on their initiated agent. Patients with pill coverage of the agents over last 90 pre-initiation days, with less than 30 supply days of the agents in the follow-up year, or with a diagnosis of depression, anxiety, DPNP, epilepsy or post-herpetic-neuralgia before the initiation were excluded.  Fibromyalgia-related medical care consumption (inpatient, outpatient, medication utilization) was compared between the two cohorts. Bootstrapping and propensity score stratification methods were used to adjust for distribution bias as well as cross-cohort differences in demographics, pre-index clinical and economic characteristics, and medication history. RESULTS: Compared to pregabalin initiators (n=4,838), duloxetine initiators (n = 3033) had a similar mean initiation age (49 years), female percentage (89%),  percentages of patients using inpatient care (11.6% vs. 11.4%), outpatient care (100%) and medications (92.7% vs. 92.8%) in the pre-initiation year.  During the post-initiation year, duloxetine initiators had fewer patients using fibromyalgia-related inpatient care (2.1% vs. 3.0%, p<0.05), fibromyalgia-related outpatient care (54.0% vs. 64.3%, p<0.05), specialty outpatient care (83.7% vs. 89.4%, p<0.05), opioids (73.5% vs. 77.1%, p<0.05), and non-steroidal anti-inflammatory drugs (38.8% vs. 41.1%, p<0.05) than pregabalin initiators did. They also had fewer inpatient admissions (0.2 vs. 0.3, p<0.05), fibromyalgia-related outpatient claims (4.7 vs. 8.3, p<0.05), specialty outpatient claims (26.1 vs. 30.4, p<0.05), and opioid claims (6.0 vs. 7.4, p<0.05). CONCLUSIONS: Among fibromyalgia patients, duloxetine initiators consumed less fibromyalgia-related inpatient, outpatient, and specialty outpatient care, and had fewer post-initiation claims for opioids.