OBJECTIVE: To determine the incidence, healthcare utilization, and costs in older adults with gout. METHODS: A 5-year retrospective case-control study of patients with incident gout and matched controls was performed. Study variables were derived from health administrative data and included patient demographics, International Classification of Diseases diagnostic codes, and healthcare cost information. RESULTS: There were 4,071 cases and 16,281 controls, providing a 5-year incidence of gout of 4.4%. The mean (+/-SD) age (77+/-7.3 and 76+/-7.1 yrs) and the male:female ratio (1.0:1.04) were similar in both groups. Gout was diagnosed by family physicians (77%), nonrheumatology subspecialists (18%), general internists (4%), and rheumatologists (0.02%). Hospitalizations were significantly higher in cases (p<0.001) in the year of diagnosis. Patients with gout had an average of 28.1 physician visits per year compared to 20.6 for controls (p<0.0001). Drug utilization for the treatment (nonsteroidal antiinflammatory drugs, colchicine, corticosteroids) and prevention (allopurinol, probenecid, sulfinpyrazone) of gout was significantly higher (p<0.0001). The average healthcare cost differential was +$134 (Cdn) per month (p<0.001) and +$8,020 per case over 5 years. These costs were due to hospital utilization (64.4%), medications (23.1%), and physician visits (12.5%). CONCLUSION: Gout is associated with a high disease burden in older men and women. The cost is primarily attributable to hospitalization, probably due to the comorbidities associated with gout. As the majority of cases are managed by nonrheumatologists, it is important that guidelines for the diagnosis and treatment of gout are disseminated to and met by all physician groups.