OBJECTIVES: Metastatic colon cancer (mCC) poses a significant burden on the U.S. healthcare system due to its high treatment costs. In this study, we analyzed differences in costs of end-of-life care between patients who withdrawn from active treatment and moved to hospice, and those who did not receive hospice care. METHODS: Retrospective analysis of cost trajectories of mCC decedents using SEER-Medicare dataset for years 2003-2010. Hospice and non-hospice patients were defined as those who had a claim within the end-of-life period defined as 7, 14, and 30 days before death. RESULTS: The study population consisted of 3,669 patients diagnosed with metastatic colon cancer between 2003 and 2009, who received at least one line of chemotherapy/biologics. On average, non-hospice and hospice patients incurred $1670.11 and $184.60, respectively, of direct medical costs on the last day of life. 30 days before death, the cost difference between hospice and non-hospice patients was equal to $40.11 (p-value = 0.0032). On the 14th, 7th and on the last day of life, cost differences were equal to $179.21, $374.35 and $1485.51, respectively (p-value = 0.0001). The major cost contributors for non-hospice patients were inpatient costs, accounting for 47.87%, 55.37%, 67.46% and 86.98% of total costs on the 30th, 14th, 7th and the last day of life, respectively; the major cost contributor for hospice patients were hospice costs, accounting for 6%, 10.95%, 16.96% and 51.72% on the 30th, 14th, 7th and on the last day of life, respectively. CONCLUSIONS: Assuming that hospice has been providing equally high quality care compared with non-hospice providers, hospice has been successful in reducing the use of health care resources among metastatic colon cancer patients.