OBJECTIVES: To evaluate cost-effectiveness of ustekinumab vs etanercept for severe psoriasis in Russia. METHODS: Cost-effectiveness analysis was performed. The data about efficacy and safety of biologic agents was analyzed. Cost-effectiveness ratio (CER) was calculated for ustekinumab and etanercept. Pharmaceutical costs were taken into account only. Achievement of PASI 75 was a criterion of efficacy, data about it was extracted from 12 weeks comparative clinical trial. RESULTS: The efficacy of  ustekinumab was higher than etanercept in a direct comparative trial (67.5 and 56.8% of patients achieved PASI 75 by week 12 respectively). Both biologic agents were generally well tolerated in most patients.  Ustekinumab was a bit less costly than  etanercept: 470.00 and 496.62 thousands rub (16.92 and 17.88 thousands $) for 12-weeks treatment respectively. Therefore CER was more favorable for ustekinumab than for etanercept: 696.30 thousands rub (25.06 thousands $)  and 874.33 thousands rub ($31.47 thousands $) per patient with PASI 75 achieved respectively. CONCLUSIONS: Ustekinumab is a dominanting alternative to etanercept for patients with severe psoriasis in Russia.