OBJECTIVES: Crohn’s disease, a chronic inflammatory condition of the gastrointestinal tract, is associated with substantial healthcare costs. Endoscopic inspection is considered essential for monitoring and optimizing treatment. Ileocolonoscopy visualizes the colon and terminal ileum but additional imaging is required to evaluate the entire bowel. Small bowel and colon capsule endoscopy (SBC-CE) evaluates the entire small bowel and colon in a single assessment. This analysis considers whether use of SBC-CE could reduce costs. METHODS:  A patient-level, discrete-event simulation evaluated care and costs (in 2016 USD) in 1,000 patients (representing 140,184 patients in the health plan) over 5 years. During each cycle, patients were exposed to the risk of disease progression, adverse events, surgery, and death. Disease state changes used underlying Markov models for development of ulcers, stricturing, rectal disease, and anatomic involvement. Treatment decisions were reviewed every 3 months using patient-reported information and marker assessment or results from endoscopic monitoring. Monitoring was performed every 3, 6, or 12 months for patients starting treatment, presenting with symptoms, or in remission, respectively. RESULTS:  SBC-CE resulted in a lower total cost of care (-1.1%, -$169.2 million). Monitoring costs (‑8.3%), adverse events costs (-2.6%), and treatment costs (-0.4%) were reduced with SBC-CE compared with ileocolonoscopy. SBC-CE identified more patients with non-symptomatic disease, moving them to treatment more efficiently. Sensitivity analyses demonstrated that model results were robust to sampled changes in input parameters, with SBC-CE resulting in a reduced total cost of care in 84.6% of simulations and a median cost saving of $3,760 per patient CONCLUSIONS: Use of SBC-CE for monitoring of Crohn’s disease can result in reduced healthcare costs. Savings are generally realized in the cost of monitoring and avoidance of adverse events associated with ileocolonoscopy.