BACKGROUND: Rheumatoid arthritis (RA) is a systemic autoimmune disease which affects 0.5% of the population in developing countries. The current biologic DMARDs approved in Brazil as 1st line therapy are: infliximab, adalimumab, etanercept, (anti-TNF therapies) and abatacept (T-cell co-stimulation therapy) or tocilizumab (IL-6 receptor antagonist). OBJECTIVES: To assess the budget impact of offering tocilizumab as an option to a pool of patients with RA in Brazil. METHODS: The perspective was from a public payer. Only direct costs were considered which comprised: drug, management and administrations costs [Scheinberg et al. 2005]. Base case dosages considered were: tocilizumab (8mg/kg dosage each 4 weeks) and infliximab [4.3 mg/kg (Ollendorf et al. 2005) at weeks 0, 2, 6 and every 8 weeks], assuming a 70 kg patient, adalimumab (40mg every other week), etanercept (50mg every week) and abatacept (750mg at weeks 0, 2, 4 and then every 4 weeks). We took the maximum price to government as a basis to all therapies [Jun, 2009]. The discount rate taken was 5% according to the Brazilian guidelines for (HTA) [Vianna et al. 2007] and a 5-year horizon was assumed. Both the treatment mix forecast and the tocilizumab penetration change were projected based on market research data. The results are expressed in 2009 Brazilian Reais (US$ 1 ≈ $Brz2.5). RESULTS:  Total annual costs were $Brz47,566 for tocilizumab, $Brz50,785 for etanercept, $Brz53,909 for adalimumab, $Brz58.603 for infliximab and $Brz50,048 for abatacept. Based on the change in the mix of treatment forecast, a total savings for a period of 5 years were $Brz674.527 for each 100 treated patients, when comparing the group of patients that received tocilizumab to the group of patients that did not receive tocilizumab. CONCLUSIONS: Findings suggest tocilizumab has the potential to offer costs reductions in the public healthcare system in Brazil.