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Aim:To examine cost and mortality differences in postmenopausal women with HR+/HER2-advanced breast cancer. Methods:Using claims data (2007–2013), women with newly diagnosed (de novo) stage IV, or early- or late-recurring metastatic breast cancer were identified. Results:Compared with de novo(n 121) and late-recurrent (n 106), early-recurrent (n 172) patients had significantly higher costs in total and for anticancer systemic agents. Adjusted per patient per month costs for early-recurrent patients were US$13,404, versus US$9955 (de novo) and US$9721 (late-recurrent; p 0.02). Early-recurrent patients’ risk of death was twice that of de novopatients (p 0.02). Conclusion:Compared with new diagnosis or late recurrence, early recurrence of HR+/HER2- metastatic breast cancer was associated with higher mortality and healthcare costs.