Objective: To describe the epidemiology, clinical features, health care resource use, treatment and outcomes of multidrug-resistant tuberculosis (MDR-TB) cases diagnosed in Western Australia, compared with matched controls with drug-susceptible TB. Design, setting and patients: Retrospective case-control study of all MDR-TB cases notified in WA between 1 January 1998 and 31 December 2012, compared with matched controls. Cases were identified and managed through the Western Australia Tuberculosis Control Program, including specialist TB services, the Mycobacterium Reference Laboratory and affiliated secondary and tertiary outpatient and inpatient medical services in WA. Main outcome measures: Demographic characteristics, clinical manifestations, treatment, outcomes and health care resource use. Results: Sixteen MDR-TB cases were notified during the study period (1.2% of all TB notifications). The median age of patients with MDR-TB was 26 years, and 15 were born outside Australia. Patients with MDR-TB were more likely to have received previous treatment (25% v 2%; P = 0.006) and had longer delays to effective therapy (median, 48 v 21 days; P = 0.002) than controls. MDR-TB patients more frequently required hospitalisation (100% v 35%; P < 0.001) and were treated for longer (mean, 597 v 229 days). Adverse effects were more commonly reported in MDR-TB patients than controls (81% v 33%; P < 0.001). Treatment success was not significantly different between patients with MDR-TB and controls (75% v 84%; P = 0.72). No treatment failures or deaths were identified in either group. Conclusion: MDR-TB remains uncommon in WA but its challenges are increasingly recognised. Despite delays in commencing effective therapy, MDR-TB is usually associated with treatment success. Adverse effects of medications are common, and treatment courses are long and complex. Specialist TB services should continue to be involved in management and prevention of all cases of MDR-TB.