OBJECTIVES: To evaluate the annual economic impact of biotherapies for the treatment of RA patients. METHODS: Target population was defined as adults belonging to RA medical Diagnosis Related Group (DRG) in the French national database of the Information System Program Management (PMSI) in hospital. The total direct costs considered were: treatment costs (current published prices, April 2009), hospitalization costs including administration cost in hospital (DRG, V11 March 2009), and for ambulatory patients the rheumatologist follow-up and subcutaneous injection costs. Treatment cost was calculated according to treatment dose, length and duration as reported in real life data. Real life data were based on a registry (AIR PR) and record from market analysis (A+A panel study March 2008). Biotherapies market share data were issued from the GFK Performance Tracker (Q3 2008). RESULTS: A total of 15,873 patients were identified in 2007 with biotherapies of Abatacept: 952 (6), €19,618 (81), €18,676,336 (8); Adalimumab: 4762 (30), €14,950 (patient injection) (99), €15,464 (nurse injection) (98), €71,252,500 (32); Etanercept: 5873 (37), €14,693 (patient injection) (99), €14,849 (nurse injection) (98), €86,575,567 (39); Infliximab*: 2381 (15), € 12,144 (84), €28,914,864 (13); Rituximab**: 1905 (12), € 6,451 1 cycle (89) €12,789 2 cycles (90), €16,029,434 (7) ; Total: 15873 (100), NA, €221,448,701 (100) for Patients N (%), Annual costs / patient (% acquisition costs), Total annual costs (%).CONCLUSIONS: In real life setting annual RA treatment costs/patient in France varies from €6,451 to €19,618 depending on the biotherapy used. Drug acquisition cost represents the major part of the annual costs. The global annual cost is €221, 448, 701.