OBJECTIVES: To compare healthcare utilization and costs between early- and late-stage Alzheimer’s disease (AD) patients residing in long-term care (LTC) facilities. METHODS: Patients diagnosed with AD (International Classification of Diseases, 9^th Revision, Clinical Modification [ICD-9-CM] code 331.0) were identified using U.S. Medicare claims linked with the Long-Term Care Minimum Data Set (MDS) from 01JULY2008 through 31DEC2010. The first diagnosis date was designated as the index date. Patients were required to be age ≥65 years, with continuous medical and pharmacy benefits for 6 months pre- and post-index date, and reside in an LTC facility. Patients were categorized as early- or late-stage. Late-stage AD was defined by a cognitive performance scale score ≥5 (range 0-6) and Activities of Daily Living short-form activities score ≥10 points. Patients with and without AD were matched based on demographic and clinical characteristics, and 1:1 propensity score matching was used to compare follow-up all-cause and AD-related healthcare costs and utilizations. RESULTS: Before matching, late-stage AD patients (n=5,323) were less likely to be white (83.0% vs. 86.4%), male (16.4% vs. 21.7%) and have comorbid conditions measured by the Charlson Comorbidity Index score (3.55 vs. 4.83, p<0.001) than early-stage AD patients (n=20,023). After 1:1 matching, 3,804 patients were matched from each cohort and baseline characteristics were balanced. Fewer late-stage AD patients had skilled nursing facility admissions (25.3% vs. 29.8%, p<0.0001), but more had hospice admissions (17.8% vs. 7.3%, p<0.0001) and pharmacy visits (85.8% vs. 81.9%, p<0.0001) than early-stage AD patients. There were no significant differences in total all-cause healthcare costs; however, late-stage AD patients incurred significantly higher disease-related total ($14,739 vs. $13,673, p=0.0242) and hospice costs ($4,157 vs. $1,553, p<0.0001) compared to early-stage AD patients. CONCLUSIONS: Patients with late-stage AD incurred higher disease-related costs than those with early-stage AD; however, there were no significant differences in total all-cause healthcare costs.