OBJECTIVES: The requirements for health technology assessment (HTA) vary between countries with respect to considering indirect costs associated with the loss of productivity. Failure to account for these costs in economic evaluations may significantly underestimate total disease burden, particularly in type 2 diabetes (T2D) where epidemiological studies show age at onset continues to decrease, whereas retirement age is increasing. The study objective was to assess the direct and indirect cost burden of T2D individuals in the US for selected age groups.  METHODS: The IMS Core Diabetes Model (CDM) was used to project the direct and indirect costs (lifetime and annual) for three newly diagnosed T2D populations of ages ranges: 35-44, 45-54 and 55-64 years. Patient characteristics were obtained from NHANES. Indirect costs were assessed using human capital approach. The cohorts were projected over a 60-year time horizon. Overall annual costs were assessed as the ratio of lifetime costs and age-specific life expectancy. Discounting was applied at 3%.  RESULTS: Projecting the younger T2D cohort (35-44 years) led to a per capita estimation of $45,094 direct lifetime costs and $59,697 indirect lifetime costs. This compared to $46,500 (direct lifetime costs) and $40,567 (indirect lifetime costs) in the 45-54 years cohort, and $39,112 (direct lifetime costs) and $9'046 (indirect lifetime costs) in the 55-64 years cohort. Overall annual per capita direct and indirect costs were assessed at $2,090 and $2,767, respectively, for the 35-44 years cohort, $2,554 and $2,228 for the 45-54 years cohort, and $2'693 and $623 for the 55-64 years cohort.  CONCLUSIONS: The consideration of indirect costs is especially relevant in younger T2D populations. Failing to include indirect cost considerations in economic evaluations leads to an underestimation of the total disease burden.