OBJECTIVES: To describe the real-world clinical complications associated with venous thromboembolism (VTE) and quantify the incremental direct all-cause and disease-specific health care utilization and costs associated with VTE. METHODS: Health insurance claims between January 2004 and December 2008 from the IMPACT database were used. Adult patients with an index VTE diagnosis (deep vein thrombosis [DVT], pulmonary embolism [PE], or both) were matched 1:1 with control patients without VTE. Each patient’s observation period began on the date of the index VTE or corresponding date for controls and ended on the earlier of 1 year after the study index date, the health plan disenrollment date, or December 31, 2008. The proportion of patients with recurrent VTE requiring hospitalization or post-thrombotic syndrome (PTS) was calculated. All-cause incremental health care costs associated with VTE and disease-specific costs related to VTE complications were also reported. RESULTS: The VTE and no-VTE cohorts (16,969 subjects in each group) were well matched for age, gender, comorbidities, and VTE risk factors. The index VTE event was DVT, PE, or both in 12,711, 2473, and 1785 patients, respectively. The risks of recurrent VTE requiring hospitalization and PTS during the 1-year follow-up period were 3.6% and 6.2%, respectively. Patients with VTE had significantly higher average yearly all-cause costs compared to no-VTE patients (mean [SD]: $33,531 [$70,393] versus $17,590 [$42,011], cost difference=$15,941; 95% CI=14,819–17,012).  Disease-specific health care costs related to VTE complications represented 18.3% ($2913 of $15,941) of the all-cause cost difference between the two groups. CONCLUSIONS: In this large matched-cohort study, VTE was associated with a 3.6% risk of hospitalization due to recurrence and a 6.2% risk of PTS at 1 year. VTE was also associated with significant health care cost burden—disease-specific costs related to VTE complications represented nearly one-fifth of the incremental all-cause costs associated with VTE.