OBJECTIVES: Pseudobulbar affect (PBA) is an underdiagnosed condition characterized by sudden, involuntary episodes of crying and/or laughing in patients with traumatic brain injury or certain neurologic diseases, including multiple sclerosis, amyotrophic lateral sclerosis, stroke, Alzheimer’s disease, and others. Studies suggest that PBA symptoms are associated with added healthcare utilization and costs. NUEDEXTA (dextromethorphan/quinidine) is the only FDA and EMA approved PBA treatment. The primary objective of this analysis is to evaluate healthcare utilization and costs in PBA patients before and after dextromethorphan/quinidine treatment. For this analysis type of service unit utilized and overall utilization are both functions of cost. METHODS: Retrospective analysis using anonymized patient level data from a large national health insurer. Claims data (both commercial and Medicare) were assessed for each eligible patient, for an observation period including the 12 months before (baseline) and 12 months after (follow-up) the Index Date, defined as the first prescription fill date for dextromethorphan/quinidine. Eligibility requirements were an Index Date between January 1, 2007 through August 31, 2013, and continuous insurance eligibility for the entire 24 month observation period RESULTS: A cohort of 1245 patients treated with dextromethorphan/quinidine was identified; 488 of whom met eligibility requirements. Mean healthcare costs, primarily driven by utilization, were reduced in the 12 months following dextromethorphan/quinidine use compared with the 12 months pretreatment, including reduction of inpatient costs (27%), emergency room visits (19%), stroke-related postcare (73%) and ancillary costs (2%). Pre-index costs were not reflective of costs related to acute stroke treatment in stroke patients, as no patient had a stroke during the 12-month pre-index (baseline) period. Despite the added prescription cost of dextromethorphan/quinidine, the overall weighted mean cost reduction was 5%.  CONCLUSIONS: Patients treated with dextromethorphan/quinidine (NUEDEXTA) showed a decrease in healthcare utilization and costs compared to the pre-index period.