Background: DD-MVAC and GC are commonly used NAC regimens for MIBC. While efficacy across studies appears similar, the resource utilization burdens have not been compared. Methods: We assessed the resource utilization and cost effectiveness of NAC with GC vs DD-MVAC for MIBC patients (pts) treated at Dana-Farber. Data on chemotherapy administered, supportive medications, relevant procedures, hospitalizations, clinic, infusion, and emergency room visits were collected retrospectively. Results: 147 patients were included, 51 in the DD-MVAC and 86 in the GC group. The two groups had similar baseline pt characteristics except lower mean age (59 vs 67 years, p<0.001) and higher proportion of ECOG-PS=0 (96.1% vs 60.5%, p<0.001) in the DD-MVAC group. The mean cumulative cisplatin dosages were similar (DD-MVAC=284 mg/m², GC= 257 mg/m³). The DD-MVAC group exhibited a greater use of G-CSF analogues (100% vs 32.6%, p < 0.001), central line placement (28.6% vs 11.8%, p = 0.017), infusion visits/pt (12 vs 8), ER visits (35% vs 18%, p = 0.048), and cardiac imaging (0.98 vs 0.58/pt, p<0.001). Patients receiving GC were more likely to experience delayed chemotherapy cycles (30.2% vs 9.8%, p = 0.008) and required more frequent clinic visits (9 vs 5/pt). The frequency and duration of hospitalization (23.6% vs 13.7% and 0.88 vs 0.49 days/pt, p = 0.46) and rate of grade ≥3 toxicities (32.6% vs 45.1%, p = 0.18) were numerically but not statistically different between the GC and DD-MVAC group. Cost efficacy analysis is pending and will be presented. Conclusions: DD-MVAC and GC exhibit different characteristics in terms of resource utilization as NAC for MIBC. Importantly, excess resource utilization did not clearly favor one of the regimens, although the DD-MVAC group was younger with better ECOG-PS. Given that similar overall delivery of cumulative cisplatin dosage was feasible with both regimens, the values and costs affixed to different resources may impact the selection of DD-MVAC vs GC in different regions of the world.