OBJECTIVES: To compare direct and absenteeism-related indirect expenditures among employees suffering from an AIID pre and post anti-TNF use. METHODS: A retrospective analysis was performed using the Thomson Reuters MarketScan® and the Health and Productivity Management databases (2000-2007).  Study group consisted of members with primary diagnosis for at least one of six AIIDs (Rheumatoid Arthritis, Psoriasis, Psoriatic Arthritis, Crohn’s Disease, Ulcerative Colitis, Ankylosing Spondylosis) and at least one prescription for an anti-TNF (adalimumab, etanercept, or infliximab) in the same calendar year. Direct expenditures included medical expenditures (inpatient, outpatient, emergency department, and other medical services) and pharmacy expenditures. Indirect expenditures included expenditures related to absenteeism. Regression analysis was used to compare the mean number of  annual absentee days, indirect expenditures associated with absences, direct expenditures (medical and pharmacy), and total expenditures during the 12 months prior versus the 12 months following initiation of anti-TNF treatment. RESULTS: The study group (n= 689) was 39% female with 94% in a managed care plan and had a mean age of 44.3 years. Only 22% had more than one AIID condition.  Following the use of anti-TNFs, absenteeism decreased by 15.4% with lower indirect expenditures ($1172 vs. $1000), lower medical expenditures ($7517 vs. $6434), and lower non anti-TNF pharmacy expenditures ($1934 vs. $1604). Direct expenditures were higher ($22,658 vs. $9450) due to the cost of anti-TNF treatment ($14,620). Consequently, total expenditures (direct and indirect) were also higher following anti-TNF use ($23,657 vs. $10,623). CONCLUSIONS: AIIDs are debilitating disorders that result in reduced productivity and time lost from work. Members with at least one AIID who received anti-TNF treatments, had lower absenteeism and indirect health care costs and higher direct costs. Appropriate management of these conditions with anti-TNF agents may provide greater indirect costs savings which could offset the direct costs.