Current first-line treatments for metastatic urothelial carcinoma include platinum containing therapy with cisplatin or carboplatin, immune checkpoint inhibitor (ICI) monotherapy, or nonplatinum-containing therapy. A retrospective observational administrative claims database (2015-2019) study of 100% Medicare-Fee-For Service patients assessed treatment patterns, overall survival, healthcare resources and costs. Platinum-containing chemotherapy was associated with longest overall survival and highest healthcare resource utilization; ICI with shortest overall survival and highest healthcare costs.