OBJECTIVES: To compare treatment costs and cost-effectiveness results for biologics approved for the treatment of moderate to severe psoriasis from the perspective of a public payer in Brazil. METHODS: Annual treatment costs were calculated based on the number of vials used, as defined in the label for each biologic, and from the price per vial. The prices of etanercept, adalimumab and infliximab were obtained from purchase disclosures by the Brazilian Ministry of Health. As ustekinumab, the latest biologic approved for psoriasis, has not yet been purchased by that Ministry, its list price after deducting the mandatory discount for government sales (22.85%) was considered. The effectiveness of each treatment was defined by a recent metanalysis as the PASI75 response at the primary endpoint for each drug. The average patient weight was assumed at 70kg. RESULTS: Ustekinumab has the lowest treatment cost across the biologics in both induction and maintenance years with the least number of vials used. With a total of 4 applications during a maintenance year, ustekinumab has the lowest treatment cost, followed by infliximab (55% more expensive), adalimumab (62% more expensive) and etanercept (75% more expensive). Combining the cost and effectiveness results, ustekinumab has the lowest cost per response, followed by infliximab (44% less cost-effective), adalimumab (104% lesss cost-effective) and etanercept (152% less cost-effective). CONCLUSIONS: With the lowest treatment cost, ustekinumab is an important treatment option in moderate to severe psoriasis. When comparing the cost-per-response across biologics, ustekinumab is further differentiated from the remaining biologics. Ustekinumab represents a rare situation in Brazil combining the lowest treatment cost and a high effectiveness result.