Background: Febrile neutropenia (FN) resulting from myelosuppressive chemotherapy can lead to increased hospitalizations and mortality. Pegfilgrastim can be used to reduce the risk of FN; however, few studies address pegfilgrastim’s value in patients with metastatic solid tumors. This observational study compared outcomes for pegfilgrastim-treated (peg-tx) and peg-untreated (no peg) patients with metastatic colorectal (CRC) at US Oncology practices (USO) participating in the Oncology Care Model. Methods: Patients with metastatic CRC treated at USO from July 1, 2013 – December 31, 2014 and a qualifying baseline OCM episode were included. Propensity scoring was used to match (1:2) peg-tx and no peg cohorts based on line of therapy, number of comorbidities, age, gender, ECOG performance status, chemotherapy neutropenic fever risk, and dose reduction. Outcomes assessed included all-cause and infection-related hospitalization rates; total cost of care per 6-month OCM episode; and overall survival (OS). Results: Matched peg-tx and no peg samples were 149:298. The all-cause hospitalization rate was higher in the peg-tx vs. no peg population, 45% vs. 32% (OR 1.7, (1.1, 2.5), p = 0.011). Infection-related hospitalization rates were no different in peg-tx vs. no peg cohorts, p = 0.367. Cost of care was significantly higher for peg-tx patients vs. no peg ($58,787 ± $20,490 vs. $37,811 ± $19,593 respectively, p< .001). OS was 19.5 months (peg-tx) vs. 19.7 months (no peg), p = 0.882. Conclusions: While peg use in curative treatment settings for high risk patients is standard of care, in our Medicare population use in metastatic CRC did not result in a lower all-cause or infection-related hospitalization rate or impact in OS. There was a higher 6-month total cost of care associated with those patients who received peg during chemotherapy.