OBJECTIVES: Currently, anti-TNFα monoclonal antibodies are the mainstay of therapy in patients with active rheumatoid arthritis (RA) and inadequate response to methotrexate (MTX) alone. The purpose of this analysis is to evaluate the cost-effectiveness of certolizumab pegol (CZP) versus other anti-TNF (adalimumab[ADA], infliximab [INF] and etanercept [ETA]) as adjunctive therapy to MTX from the perspective of the Brazilian private health care system. METHODS: Cost-effectiveness for 52 weeks of treatment was evaluated based on the ACR20 response rate at week 24 based on main published RCTs for each anti- TNF. An indirect comparison was performed using Glenny et al method1. Annual drug costs for each aTNF were calculated from their published ex-factory prices and their recommended dosing schedule in the Brazilian product information. For the calculation of the annual INF cost, the initial weight of the patient assumed for the model was assumed to be 65Kg, with no increment of the doses after 22 weeks. Results are presented in USD (June 11th, 2012 exchange rate) annual costs and incremental cost-effectiveness ratios (ICER’s). A sensitivity analysis was made on price discount rate. RESULTS: Annual costs were estimated in USD $12,619, USD $39,305, USD $24,267 and USD $35,617 for CZP, ADA, INF and ETA, respectively. Adjusted by indirect comparison of ACR20 response were 77% for CZP and 67%, 61% and 45% for ADA, INF and ETA, respectively. The cost effective ratio was USD $16,484 for CZP and USD $79,742, USD $59,326, USD $40,299 for ETA, ADA and INF respectively. The cost-effectiveness analysis demonstrated that CZP was a dominant strategy compared with ADA, INF and ETA.   CONCLUSIONS: Certolizumab pegol (CZP) is a cost- saving anti-TNF option for treating RA from a Brazilian private health care perspective.