OBJECTIVES: Infliximab (I) 5mg/kg is effective to control refractory Crohn’s disease in 81% and to improve fistulas in 68% of patients, thus greatly improving quality of life (QoL). The objective of this study was to calculate the direct costs and savings generated by I to achieve this improvement of QoL. METHODS: This mirror-image study was carried out in 48 patients, of which 22 with fistulas, all responding to therapy. Patients were followed for 6 to 24 months prior and 6 to 24 months after I. All direct costs to the Belgian public payer were recorded separately for every 6 month time period before and after I, in order to control for a bias due to changed management regardless of I. The cost of I was calculated separately. IBDQ scores were recorded before and after I for each period. RESULTS: There was an important built up of costs in each period before I: -2-1.5y: 1,002 (±459) Euro; -1.5-1.0y: 1,486 (±459) Euro; -1.0-0.5: 2,114 (±391) Euro; -0.5-0: 2,427 (±302) Euro. After I there was a sharp decrease of the cost of care (excluding the cost of I) to 1,760 (±239) Euro (0+0.5y) and 1,380 (±264) Euro (+0.5+1.0y). The decrease was statistically significant (p=0.016). The average cost of I in the first six months was 4,850 (±327) Euro and in the second six months 1,300 (±280) Euro. The IBDQ increased from 147.8 (SE 8.4) to 187.8 (SE 7.0). The total direct cost of care after I, adjusted for the non-responders, was calculated to be 17.0 Euro per day of normalised QoL. CONCLUSIONS: Although the cost of Remicade is substantial, the total direct cost to produce a normal QoL in the entire year after therapy is quite acceptable, providing that patients not responding are not further treated.