OBJECTIVES:  Up-to-date estimation of healthcare costs in Ulcerative Colitis (UC) and Crohn’s Disease (CD) patients is crucial to inform budgeting and resource allocation decisions. Recent introduction of biologic therapies rendered previous cost studies with standard therapy obsolete. We sought to determine healthcare costs in a consecutive sample of real-world UC and CD patients managed in a specialized facility in a tertiary referral center in Israel. METHODS: Data-bases of patients enrolled in an ongoing socio-economic study were mined to determine healthcare resource utilization during the years 2012 and 2013. This included direct charges for in-patients and out-patients, hospitalizations, investigations and medical and surgical treatments. Prices were obtained from the Ministry of Health Tariff (12/2014) and expressed as US $. Data express costs related to UC and CD patients, excluding any treatments for co-morbidities. RESULTS: This adult cohort had a mean age of 45.1 ± 17.2 years, with M:F ratio 1.04. The mean [median] healthcare cost/patient was: UC, 2012 (n=273): $1,710 [$847], 2013 (n=280): $1,983 [$916]; CD, 2012 (n=263): $4,231 [$1,450], 2013 (n=280): $4,568 [$1,169]. Between-year differences in costs were not statistically significant. Over the two-year period, the major cost drivers in UC were procedures (37.3% of costs), consultations (20.4%), biologic medication (17.8%), standard medication (13.5%) and hospitalization (9.4%).  In CD, the cost drivers were biologic medication (47.4%), surgery (13.8%), procedures (12.1%), consultations (11.21%), hospitalization (10.7%) and standard medication (4.8%). Mean biologic medication cost/patient in UC increased from $293 in 2012 to $352 in 2013; and for CD from $1882 to $2289 respectively. This paralleled an increase in the number of patients receiving biologic medication from 65 in 2012 to 76 in 2013; of these, 81% had CD CONCLUSIONS: CD patients engender much higher healthcare costs that those with UC. Expensive biologic medication now becomes the major cost driver in CD, but not UC, patients in the current era.