OBJECTIVES: Recent systematic literature reviews of bladder cancer (BC) indicated that more economic research on management strategies, particularly in the metastatic setting, is needed. This study evaluated the cost of care among patients diagnosed and treated for BC with and without metastases. METHODS: Retrospective data from 2 large integrated claims databases spanning July 2008 to December 2010 were used to identify adult patients with a diagnosis of malignant neoplasm of the bladder (ICD-9 188.0–188.9; ICD-10 C67.0–67.9). Patients were included if they (1) had continuous eligibility for 6 months prior to at least 6 months following their index diagnosis, (2) had no diagnosis of any other cancer in the pre-period, and (3) received no chemotherapy in the pre-period. Patients were stratified into 2 cohorts based on the presence of metastatic disease within 180 days of diagnosis: non-metastatic (NM) and metastatic (M). Resource use and all-cause costs (2013 USD) were evaluated after cancer diagnosis.  RESULTS: There were 10,250 (9,268 NM, 982 M) and 22,965 (20,786 NM, 2,179 M) patients in each of the databases meeting all inclusion criteria, respectively. Mean follow-up was 35.1 months and 38.6 months in the 2 datasets. Total costs 6 months prior to index ranged from $6,497–$6,852 (NM) and $6,766–$7,831 (M) and increased to $13,127–$13,559 (NM) and $40,695–$45,817 (M) in the 6-month post-index period. The majority of costs in the 6-month post-index period were attributable to medical services: NM, 88.7%–91.8%; M, 94.8%–96.5%. Inpatient and emergency department costs accounted for 38.2%–40.8% (NM) and 50.4%–52.5% (M) of total medical costs.  CONCLUSIONS: Healthcare costs are highest among BC patients with metastatic disease, totaling as much as $45,817 in the 6-month period after diagnosis.  Approximately 50% of costs are related to inpatient and emergency department services.