OBJECTIVES: Inflammatory bowel disease (IBD) affects 1-1.4 million people in the United States. IBD affects people during their economically productive adult lives and can have potential economic impact of IBD on productivity loss in the workforce. We compared risk, absenteeism, and medical/pharmacy costs for employees with IBD and five most prevalent chronic conditions. METHODS: Health-risk information and self-reported illness days using health-risk assessment (HRA) data were examined and direct Healthcare costs (medical and pharmacy) using claims data for employees, retirees, and their adult dependents of a large self-insured employer were compared from 2002-2006 among individuals with IBD and five most prevalent chronic conditions; asthma, coronary artery disease/congestive heart failure (CAD/CHF), diabetes, hypertension, chronic obstructive pulmonary disease (COPD).  RESULTS: 44 individuals with IBD were identified. The IBD cohort had moderate health-risk score (2.6/5) which was comparable to individuals with asthma (2.8/5), CHF (2.9), hypertension (2.6) and lower than diabetes (3.2/5) and COPD (3.4/5). Whereas, higher proportion (31.8%) of individuals with IBD had >5 illness days per year as compared with individuals with asthma (31.8%), CAD/CHF (25.9%), hypertension (20.4%), diabetes (28.4%), and COPD (33%). Annual direct healthcare costs were higher for individuals with IBD ($24,911) as compared to individuals CAD/CHF ($22,916), and hypertension ($18,632), and lower as compared to individuals with asthma ($25,814), diabetes ($28,035), and COPD ($38,839). CONCLUSIONS: Individuals with IBD have similar health-risks but higher illness days, and direct healthcare costs as compared to the individuals with five most prevalent chronic conditions. IBD is a high costs and lost productivity driver for employers. Population health based programs that engage employees in appropriately managing their chronic conditions can help employers reduce health-risks, improve productivity, and may help reduce healthcare costs as well.