OBJECTIVES: Crohn’s disease (CD) is a chronic inflammatory disease of the gastrointestinal tract which can cause abdominal pain, diarrhea and weight loss.  Anti-TNFα drugs are being used more often and earlier in the disease course of patients with CD who have aggressive disease. However, these medications are quite expensive. The objective of this study is to evaluate the cost-utility of two anti-TNF drugs (infliximab, adalimumab) for refractory CD. METHODS: A Markov model was used to estimate the costs and utilities (QALYs) of three treatments (usual care, infliximab, adalimumab) over a 5 year time horizon.  After initial treatment, patients can achieve complete remission, treatment response or remain in a drug refractory health state.  Patients achieving remission or response remain at risk of relapse during each 3 month model cycle. Patients in the drug refractory health state can either stay in that health state or have surgery during each cycle. Estimated costs and utility values were then assigned to the various model health states. Model input parameters, including initial response rates, relapse rates and utility values were derived from the published literature. RESULTS: Usual care had both the lowest expected costs ($17,017) and QALYs (2.555), while infliximab had both the highest expected costs ($54,084) and QALYs (2.721). The incremental cost per QALY moving from usual care to adalimumab and from adalimumab to infliximab was estimated to be to be $193,305 and $451,165, respectively. CONCLUSIONS: Based on common willingness to pay thresholds, ant-TNF drugs would not be perceived as a cost effective treatment for refractory CD.