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OBJECTIVE:To quantify and compare employee health- and productivity-related costs for current smokers versus nonsmokers for a large US employer. METHODS:Multivariate regression models were used to compare medical, pharmacy, workersʼ compensation, and short-term disability costs, self-reported absenteeism, and presenteeism by smoking status. Costs were aggregated over 3 years, from 2008 to 2010. RESULTS:Controlling for demographic variables, smokers had significantly different health care utilization patterns, as well as higher absenteeism and presenteeism costs. Overall, employees who smoke were estimated to cost employers $900 to $1383 more than their nonsmoking counterparts. CONCLUSIONS:Current smokers experience incrementally greater lost productivity than nonsmokers, contributing to employer costs associated with smoking. Increased employer focus on smoking cessation may help mitigate these organizational costs.