OBJECTIVES: To estimate medication adherence, healthcare resource utilization and direct medical costs of Alzheimer’s Disease (AD) patients in Tianjin, China. METHODS: Data were obtained from the Tianjin Urban Employee Basic Medical Insurance database (2010-2014). AD patients ≥60 years, initiated oral AD medication (Donepezil, Rivastigmine, Memantine, Huperzine A or Oxiracetam) from January 1, 2011 through December 31, 2013, had continuous enrollment for 12 months pre-initiation (baseline) and 12 months post-initiation (follow-up) period, and had ≥2 prescriptions during the follow-up period were included. Adherence was measured by Medication Possession Ratio (MPR) with ≥0.8 or ≥0.5 were deemed adherent, respectively. All-cause and AD-related healthcare resource utilization and direct medical costs during follow-up period were assessed. RESULTS: A total of 1,227 patients (52.9% male; mean age 73.4±7.6 years; Quan-CCI 0.61±1.19) were identified. The mean MPR among the cohort was 0.19±0.16, with 0.65% (N=8) MPR ≥0.8 and 5.46% (N=67) MPR≥0.5. Compared to the baseline, a significant increase in all-cause direct medical costs was observed in new AD patients during the follow-up period ($944 vs. $4,288, p<0.001). Adherent patients (MPR≥0.5) utilized more AD-related healthcare resources including higher frequency of hospitalization (0.76 vs. 0.31, p<0.001), longer length of stay (30.03 vs. 5.57, p<0.001) and higher number of outpatient visits (15.61 vs. 4.31, p<0.001) than non-adherent patients (MPR<0.5). The AD-related direct medical costs for adherent group (MPR≥0.5) were significantly higher than non-adherent group ($3,906 vs. $1,577, p<0.001), while their all-cause direct medical costs were similar ($5,116 vs. $4,240, P=0.350). CONCLUSIONS: The adherence to oral AD medication was poor in Tianjin patients compared to international reports. New AD patients incurred great increase in healthcare resource utilization and economic burden. The comprehensive impact of disease severity, patient knowledge, medication therapy and reimbursement policy may result in the poor adherence and utilization characteristics reported, which deserves further investigation to promote AD management in China.