OBJECTIVES: Gastric cancer (GC) is the fourth most common cancer globally and an important cause of morbidity and mortality in the US. Prognosis is poor, treatment options are limited, and there has been little progress in improving outcomes over the last 25 years. The objective of the study was to describe the demographic and clinical characteristics, mortality, healthcare utilization and cost of patients with gastric cancer. METHODS: A retrospective cohort study on GC and non-cancer patients was conducted using the HealthCore Integrated Research Environment during 2007-2012. GC cases were ≥18 years, had at least 2 diagnosis codes for GC within 60 days (first diagnosis was index) and had 12 months pre-index history. GC patients were matched 1-to-10 with patients having no diagnosed cancer on age, gender, health plan type, and geographic region. Descriptive analyses were performed for healthcare utilization and cost, and mortality. Stratified analyses were conducted by patient age, site of cancer and coding for metastatic disease. RESULTS: There were 1,668 GC cases and 16,680 cancer free patients. Mean age was 66 years and 65% of patients were male. Patients with GC incurred more than ten times the healthcare costs than those without cancer ($96,571 vs. $8,338) during the follow-up period, particularly those with advanced disease ($131,663). When including only those costs specifically linked to gastric cancer, these differences remain. Three-year survival was 45% and 94% in patients with GC and without cancer, respectively (hazard ratio=14.9). Chemotherapy and/or chemo-radiation without curative surgery was the most common treatment seen in GC patients during the first 18 months of follow-up (53%); trastuzumab use was only detected in 17 patients. CONCLUSIONS: GC represents a significant burden both to the individual and healthcare system, with considerably higher resource use and costs than matched patients without cancer.