OBJECTIVES: RA prevalence is <0.5% in Turkey.  This rate, as those in other Mediterranean countries, is lower  compared with other European countries,. Initial RA treatment consists of using Disease Modifying Anti-Rheumatic Drugs (DMARDs). Following inadequate response to DMARDs patients may switch to biologic treatment options including tumour-necrosis factor (TNF) inhibitors. Tocilizumab is approved by Turkish Ministry of Health for the treatment of active RA patients who have responded inadequately to previous anti-TNF therapy. The study aimed to assess tocilizumab’s cost-effectiveness for treatment of active RA patients with inadequate response to previous anti-TNF treatment in Turkey.  METHODS: Cost-effectiveness analysis performed from payer’s perspective considered direct medical costs. Markov model was used to compare two treatment sequences:1) tocilizumab, rituximab, abatacept, leflunomide, cyclosporin, palliative care, and 2) rituximab, abatacept, leflunomide, cyclosporin, palliative care. Time horizon was end of life. Patient characteristics were based on phase III study data (RADIATE). Mixed treatment comparison was used to adjust ACR response rates for each of the treatments in both sequences. Relationship between HAQ-DI scores and EuroQol (EQ-5D) utilities was modeled by using patient data from trials. Resource use was estimated based on expert opinion. Treatment costs (drug acquisition, administration, monitoring) were obtained from official lists published by Turkish Ministry of Health and public payer. Costs and effects were not discounted. Results were tested using deterministic and probabilistic sensitivity analyses.  RESULTS: Treatment sequence initiated with tocilizumab resulted in 0,528 life years gained and 1,873 QALYs more than alternative sequence at an additional cost of TRY63.788. ICER was TRY34.052/QALY, which is below the threshold (TRY53.000/QALY based on WHO recommendation). Sensitivity analyses confirmed that ICER was below the threshold in 97% of the samples.  CONCLUSIONS: Treatment initiated with tocilizumab in active RA patients with inadequate response to previous anti-TNF treatment is cost-effective compared to alternative treatment sequence in Turkey.