BACKGROUND AND AIMS: There are few studies on the cost-effectiveness of telemedicine for inflammatory bowel diseases. We assessed the long-term cost-effectiveness of a telemedicine solution compared to standard care (sCare), as well as its efficacy according to patient-reported outcomes (PROs). METHODS: Between 2015 and 2020, we conducted a retrospective, register-based study among patients with ulcerative colitis and Crohn's disease. Direct and indirect healthcare costs over a 5-year period were obtained from Danish registers and compared to a control group. Costs were estimated on a yearly basis from 1 year before, until 5 years after, inclusion in the trial. Patients were divided into 2 groups: those not receiving biologics (Cohort 1) and those receiving biologics (Cohort 2). RESULTS: We recruited 574 patients with inflammatory bowel diseases. In Cohort 1 (61.5%), average total direct costs and total earnings per patient per year were €14 043 and €307 793, respectively, in telemedicine compared to €16 226 and €252 166, respectively, in sCare. In Cohort 2 (38.5%), average total direct costs and total earnings were €73 916 and €215 833, respectively, in telemedicine compared to €41 748 and €203 667, respectively, in sCare. PROs showed improved quality of life, which was higher in Cohort 1 than in Cohort 2. Disease activity among patients with Crohn's disease increased after Years 3 and 4 in Cohorts 1 and 2, respectively. CONCLUSION: Telemedicine is cost-effective for patients not receiving biologics. However, treatment with biologics is more expensive for patients enrolled in telemedicine. Careful attention to PROs in telemedicine improves quality of life and could prolong the time to relapse.