Background: Pediatric acute lymphoblastic leukemia (ALL) treatment regimens are lengthy, and there is limited data on the systemic and individual economic burden associated with treatment of ALL. Objective: This study aims to examine healthcare resource utilization (HCRU) and costs accrued during the first year of therapy among pediatric ALL patients, and to compare costs among those who are Commercially and Medicaid insured. Methods: Administrative claims data from 2011-16 were analyzed utilizing IBM MarketScan. Newly-diagnosed ALL patients with at least 12 months of enrollment were studied. Demographics and HCRU and costs were stratified by insurance type. The mean (standard deviation (SD) HCRU and reimbursed costs were measured during the first year post-diagnosis. Multivariable generalized linear models were run for total healthcare costs. Results: 730 (528 Commercial) patients with median age of 6 years were studied. During the 12 months following diagnosis, the mean(SD) inpatient admissions and ER visits for Commercial and Medicaid patients was 6.2(3.7) vs. 6.0(4.6), p=0.6310 and 2.8(6.4) vs. 2.1(2.6),p=0.0380, respectively. Commercial patients experienced more outpatient visits (77.2(28.1) versus 57.4(33.3), p<0.0001) and less pharmacy claims (54.1(22.9) and 61.0(41.8),p<0.0001) versus Medicaid patients. Total healthcare costs were $535,135.89($547,506.23) versus $198,694.94($181,856.27),p<0.0001 for Commercial and Medicaid patients, respectively. When adjusted for age and gender, total healthcare costs in the year post-diagnosis for Commercial patients were 1.60 times the costs in patients with Medicaid. Conclusion: Pediatric ALL patients have high HCRU and incur significant economic burden. The total cost of care for Commercially insured patients is more than double that of Medicaid insured patients.