Abstract Results of economic evaluations are often strongly influenced by estimates of indirect costs. International comparability of these estimates may contribute to rational decision-making in health care policy. Hence, estimates should be international comparable. Comparability of these results between countries may be hampered due to variation in methodology, data sources, valuation of production losses, and social security arrangements. Furthermore differences in epidemiology, demography and economic environment may cause variation in the level and the distribution by diagnosis of indirect costs. In this study indirect costs of disease for the Netherlands are compared with estimates for Sweden and the United States. We found large differences: both in the share of indirect costs in GDP as in the constituting elements, absence from work, disability and mortality. The level of indirect costs due to absence from work and the distribution according to diagnosis are quite similar for the two European countries. The costs of disability are particularly high for the Netherlands. Comparison of disability costs between the three countries is hampered due to lack of quantitative information on the influence of social insurance arrangements on the level of indirect costs and the distribution by diagnosis. The large number of deaths at young age in the U.S. is responsible for the higher mortality costs compared to the two European countries.