OBJECTIVES: To evaluate the economic burden and health care resource utilization of chronic obstructive pulmonary disease (COPD) in the US Veterans Health Administration (VHA) population.  METHODS: Patients diagnosed with COPD (International Classification of Diseases 9^th Revision Clinical Modification diagnosis codes 490.xx-491.xx) were identified using VHA claims from 01OCT2009 through 30SEPT2014. The first diagnosis date was designated as the index date. A comparison cohort (patients without a COPD diagnosis) was created for patients of the same age, gender, race, index year, and baseline Charlson Comorbidity Index score as patients in the COPD cohort. To reduce selection bias, a random index date was chosen for the comparison cohort. Patients were required to have continuous medical and pharmacy benefits 1 year pre- and post-index date. One-to-one propensity score matching (PSM) was performed to compare follow-up health care costs and utilization between the cohorts, adjusting for demographic and clinical characteristics. RESULTS: Eligible patients (N=925,970) were identified for the COPD and comparison cohorts. After 1:1 PSM, a total of 308,089 patients were matched from each cohort and baseline characteristics were well-balanced. COPD patients had a higher percentage of health care resource utilization, including inpatient visits (12.04% vs. 2.83%, p<0.0001); outpatient visits (99.72% vs. 77.43%, p<0.0001); and pharmacy visits (91.35% vs. 68.37%, p<0.0001) than non-COPD patients. Higher health care resource utilization translated to higher costs for COPD patients, including inpatient ($3,845 vs. $812, p<0.0001), outpatient ($5,060 vs. $2,582, p<0.0001), pharmacy ($804 vs. $481, p<0.0001), and total costs ($9,709 vs. $3,875, p<0.0001) than non-COPD patients. CONCLUSIONS: US veteran patients diagnosed with COPD have a higher economic burden compared to those who were not.