OBJECTIVES: To examine the economic burden and health care utilizations of bipolar disorder patients in the U.S. veteran population.  METHODS: A retrospective database analysis was performed using the Veterans Health Administration Medical SAS datasets from October 1, 2007 through September 30, 2012. Adult patients diagnosed with bipolar disorder were identified using International Classification of Disease, 9^th Revision, Clinical Modification (ICD-9-CM) diagnosis codes 296.0x, 296.1x, 296.4x, 296.5x, 296.6x, 296.7x and 296.8x. The first diagnosis date was defined as the index date for the bipolar disorder cohort. A comparator cohort of patients without a bipolar disorder diagnosis was created using 1:1 propensity score matching to adjust for demographic characteristics and baseline Charlson Comorbidity Index scores. The index date for the comparator cohort was randomly chosen to reduce selection bias. One-year continuous enrollment was required before and after the index date for both cohorts. Study outcomes, including health care costs and utilizations, were compared between the disease and comparator cohorts.  RESULTS: After 1:1 matching, a total of 187,530 patients with proportionate baseline characteristics were matched from each cohort. The bipolar cohort had higher percentages of inpatient stays (18.72% vs. 2.56%, p<0.0001) and emergency room (ER) (22.51% vs. 7.82%, p<0.0001), physician office (99.40% vs. 55.89%, p<0.0001), outpatient (99.55% vs. 56.73%, p<0.0001) and pharmacy visits (91.83% vs. 54.65%, p<0.0001). Bipolar disorder patients also incurred higher inpatient ($6,126 vs. $775, p<0.0001), ER visit ($265 vs. $72, p<0.0001), physician office visit ($4,149 vs. $1,365, p<0.0001), outpatient visit ($4,566 vs. $1,538), pharmacy ($952 vs. $414, p<0.0001) and total costs ($11,645 vs. $2,728, p<0.0001) compared to patients without the disorder.  CONCLUSIONS: In this study, bipolar disorder was associated with higher health care resource utilization and a significantly higher economic burden.