OBJECTIVES:: Given the similar profiles of efficacy and safety between adalimumab and infliximab, this study aim to conduct a cost-minimization analysis comparing them for moderate to severe ulcerative colitis (UC) refractory to conventional therapy from a payer perspective in Mexico. METHODS:: A decision tree model was constructed to assess the incremental cost of adalimumab versus infliximab over a 1-year period. Efficacy and safety data were obtained through a systematic literature review of 5 meta-analysis published between 2006-2016. Treatment was divided into induction and maintenance phases. All patients were assumed to complete induction; patients were then treated in the maintenance phase according to initial treatment response:1) Primary treatment failure, resulting in surgery, 2) Controlled UC on initial dose and 3) Controlled UC with medical action following secondary loss of response. Medical action was defined as dose escalation or biologic switch (infliximab/adalimumab). In the base case, all patients had dose escalation when experiencing secondary loss of response to infliximab or adalimumab. Two scenario analyses were conducted for action to secondary loss of response: 1) all patients switched biologic and 2) patients had either dose escalation or biologic switch. Direct costs were estimated based on public prices and no discount rate was applied; drug wastage impact was analyzed. An indifference point analysis was conducted by varying patient weight (base case: 77kg). RESULTS:: Adalimumab showed savings of 7,017 MXN, 7,462 MXN and 21,113 MXN per patient for the base case and scenarios 1 and 2 respectively, and of 1,102 MXN, 1,542 MXN and 16,287 MXN, respectively, when considering no drug wastage. The results were sensitive to patient weight, acquisition costs, and drug wastage. The cost indifferent point was 71 kg. CONCLUSIONS:: The model demonstrated that adalimumab is a cost-minimizing option when used as the initiation biologic for patients refractory to conventional therapy.