INTRODUCTION: This study aims to estimate the drug treatment costs and health services utilisation costs among people who used different treatment modalities to treat methamphetamine dependence. METHODS: This is a sub-study of a prospective observational cohort study MATES (n = 501), including recruitment from 15 residential rehabilitation services, 13 counselling services and 11 detoxification units in Sydney and Brisbane, Australia. Participants with methamphetamine dependence who had used methamphetamine in the 28 days before baseline assessment and completed 3- and 12-month follow-ups were included (n = 323). Unit costs per day/episode of each treatment type were taken from published literature. Self-reported health services utilisation (HSU) was collected via structured face-to-face and telephone interviews. Hospital admissions were allocated a likely diagnosis grouping from the Australian Refined Diagnosis-Related Groupings. Emergency department presentations were allocated a likely triage category. RESULTS: Average drug treatment costs per person per year were AU 0,540 (SD 13,995), accounting for 63% of total health-care costs, which were AU 6,862 (SD 19,908). Drug treatment costs of counselling participants were only around 40% of detox and residential rehab participants. However, the HSU costs of detox and rehab participants were approximately 60% lower than those of counselling participants. DISCUSSION AND CONCLUSIONS: Drug treatment costs accounted for more than half of total health care costs, representing a substantial financial burden. Detox and rehab treatment costs more but saved costs in health services use. HSU costs among people who had severe mental health problems and injected methamphetamine were substantially high. Strategies to support these groups are necessary to reduce the cost burden.