OBJECTIVES:  We sought to assess health service use, cost, and survival in localized esophageal cancer patients treated with an integrated photodynamic therapy (+PDT) algorithm, compared to +non-PDT ablation therapy or radiation (alone or with chemo). METHODS: Retrospective cohort analysis using SEER-Medicare linked data. Patients diagnosed with localized esophagus cancer between 2000 and 2007were identified and retrospectively followed for one-year pre and up to five-year post diagnosis. Cox regression models were used to study the association between all-cause survival and treatment. We analyzed health service use and cost of care for PDT, non-PDT ablation treatment, radiation with chemo and radiation only groups using Poisson (Zero-inflated) and GLM log-link model respectively. RESULTS: Of the localized esophagus cancer cohort (n=4929), 69 received +PDT, 156 received +non-PDT ablation, 861 received radiation with chemo and 1283 received radiation alone. Compared to the other groups, the +PDT cohort was older (mean age 76.3, SD 7.9), had higher proportion of Caucasians (97%), those married (70%) and those with one or more comorbidity (65%). Un-adjusted five year survival days were highest for +PDT group (mean days 1259, SD 659), followed by +non-PDT ablation group (mean days 1072, SD 672), and radiation chemo group (mean days 777, SD 633), (p <.0001) compared to radiation alone group. Also, unadjusted mortality was consistently lower for the +PDT group compared to other groups. After adjusting for socio-demographic and clinical covariates, patients receiving + PDT showed lower hazard of overall five year mortality (HR=0.35, CI=0.24, 0.49) compared to radiation only group. Five year medical care cost was higher for +PDT group (β=0.7076, p=0.0010), compared to the radiation only group. CONCLUSIONS:  In localized esophagus cancer patients, adding PDT to treatment algorithm showed trend towards improving all-cause and esophagus cancer-specific survival. Ongoing outcomes studies will further evaluate survival, cost and quality of life metrics.