OBJECTIVES:  To assess annual health care resource utilization and direct medical costs for patients with epilepsy in Tianjin, China. METHODS: Cross-sectional data were obtained from 30% random sampling Urban Employee Basic Medical Insurance (UEBMI) claims of Tianjin from each year of 2008 to 2013. The epileptic patients with ≥ 1 diagnosis of epilepsy (ICD-10-CM G40/G41) before and in each calendar year were selected. All-cause and epilepsy-related health care resource utilization  and costs of inpatient, outpatient and special outpatient service were assessed and comparisons were further conducted between “refractory” patients (treated with ≥ 3 antiepileptic drugs in study period) and “non-refractory” patients (treated with ≤ 2 antiepileptic drugs in study period) using t-tests and chi-square tests. RESULTS:  Over 5-year period (from 2009 to 2013), the prevalence increased from 0.84‰ to 3.05‰. The sample patients aged 57.1 years, with 43.0% female and 15.9% of refractory in 2013. For epilepsy-related health services, 17.6% of patients experienced ≥1 hospitalizations in 2013, with decreased mean length of stay (2009: 48.5, 2013: 35.0), 83.8% of patients experienced ≥1 outpatient visits in 2013, while the corresponding proportions for special outpatient visits were 13.4% with increased mean number of visits (2009:3.6, 2013:14.0). The epilepsy-related costs per patient decreased from 2009 ($1346) to 2013 ($1130), among them the drug costs were the largest component (60.0%), followed by therapeutic costs (15.4%) and examination costs (12.9 %). The all-cause costs stay relatively constant and were $2834 in 2013. Refractory cohort incurred significantly higher epilepsy-related costs than non-refractory cohort ($2237 vs $921, P<0.001, 2013), which was driven by higher hospitalization rates (26% vs. 16%, P<0.001, 2013).  CONCLUSIONS: A decreased trend of annual epilepsy-related costs over a five-year period was associated with the less uses of inpatient services. Refractory epilepsy patients had as twice as much the cost of non-refractory patients.