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This study investigates the associations between Effort-Reward-Imbalance [ERI], Overcommitment [OC], Job-Demand-Control [JDC] and Organizational Injustice [OIJ]) with employee well-being, absenteeism and presenteeism, as well as the costs incurred.Cross-sectional data from 1440 German pharmaceutical company employees assessing job-stress, employee well-being, absenteeism, and presenteeism were used. Linear regression and interval regression analyses assessed separate and independent associations and sample-specific costs were estimated.All four stressors were related to employee well-being, presenteeism and absenteeism when analysed separately. OIJ showed the strongest independent association with absenteeism (coef. = 0.89; p < 0.01), while OC was most strongly independently associated with lower well-being (coef. = −0.44; p < 0.01). and higher presenteeism (coef. = .28; p < 0.01). Absenteeism costs per employee/year were higher than presenteeism costs.Occupational health interventions reducing job stress will have strong potential for productivity raise and lower costs.