OBJECTIVES: Thromboembolic (TE) events are a major complication of polycythemia vera (PV).  Little is known about economic implications of TE events in such patients.  This study aims to assess the incremental health care resource use (HCRU) and costs associated with PV and post-PV TE events in a real-world patient population. METHODS: We conducted a retrospective cohort study of PV patients aged <65 years enrolled in employer-sponsored commercial health plans in the US.  Annual all-cause and PV-related HCRU and costs (adjusted to 2014 US dollars) among PV patients were compared against non-PV comparison subjects who were propensity-matched on demographics and comorbidities.  For patients with a post-PV TE event, average 12-month costs following index TE event were assessed.  Costs were also analyzed in a subgroup receiving hydroxyurea treatment. RESULTS: A total of 12,990 PV patients (diagnosed 2000-2012) were included.  HCRU was generally higher among PV patients versus matched comparison subjects, with largest difference observed for outpatient hospital visits (90% vs. 70% respectively, p < 0.0001).  Mean all-cause annual total costs among PV patients were significantly greater than comparison subjects ($17,418 vs. $10,501, P < 0.0001).  In a subset of patients treated with hydroxyurea (n=774), mean PV-related annual total costs ($7,657) were nearly 3 times higher in contrast to costs observed among all PV patients ($2,535).  Among PV patients experiencing TE events, mean 12-month all-cause costs were more than 4 times higher than among those with no TE event ($48,211 vs. $10,958, P < 0.0001). CONCLUSIONS: Total all-cause HCRU and costs in PV patients were substantially higher compared to a matched non-PV comparison group.  Patients receiving hydroxyurea had higher costs, potentially reflective of inherently more severe disease in this patient subgroup.  Costs were also substantially higher among patients experiencing post-PV TE events, highlighting the importance of treatments that may reduce cardiovascular complications in patients with PV.