OBJECTIVES: To compare direct and absenteeism-related indirect expenditures among employees with inflammatory bowel disease (IBD) (Crohn’s Disease, Ulcerative Colitis) with employees who do not have IBD.  METHODS: A retrospective analysis was performed using the Thomson Reuters MarketScan® and the Health and Productivity Management databases between 2000-2006. Propensity analysis adjusting for various demographic and clinical variables was used to create 1) control: no diagnosis of any IBD; and 2) IBD group: primary diagnosis of at least one IBD. 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 between the two groups.  RESULTS: The 2201 employees in the IBD group were matched to 8,788 employees in the control group (mean age 42.2 years; mean risk score was 3.43; 40% female; with 94% in managed care). Compared to the control group, the IBD group had slightly higher rate of absenteeism (9.1 vs. 9.0 days, slightly higher indirect expenditures ($1170 vs. $1129), higher direct expenditures ($8870 vs. $7500) including medical expenditures ($6860 vs. $6096), and non anti-TNF pharmacy expenditures ($1609 vs. $1404). The total expenditures (direct and indirect) were also higher for the IBD group ($9950 vs. $8630) compared to the control group. CONCLUSIONS: IBD is a debilitating disease that results in reduced productivity and time lost from work. Employees with IBD have a higher total health care expenditure burden. Appropriate management of IBD can reduce costs for employers and payers. Further analyses are needed to determine the impact of various treatment(s) on lost productivity and direct and indirect expenditures.