OBJECTIVES: To determine the cost-effectiveness of biologic drugs for moderate to severe psoriatic arthritis (PsA) using a 40-year German healthcare perspective. METHODS: A network meta-analysis of 8 biologics RCTs determined short-term efficacy using Psoriasis Area and Severity Index 75% (PASI75) and American College of Rheumatology (ACR) responses and Health Assessment Questionnaire (HAQ) and PASI improvements. Published evidence and assumptions were used to predict long-term efficacy using a decision analytic model. Costs included drug acquisition, administration, monitoring, and hospitalisation. Incremental cost-effectiveness ratios (ICERs) were calculated using Quality Adjusted Life Years (QALYs), function (HAQ-adjusted life years), and years in PASI75 response. RESULTS: For the QALY analysis, golimumab was extended dominated by adalimumab. The incremental costs and QALYs for adalimumab vs. palliative care were €32046 and 0.671, producing an ICER of €47728/QALY. Etanercept was estimated to provide marginally more QALYs (0.060) at an additional €3461 (ICER of €57380/QALY vs. adalimumab). Although infliximab was estimated to give the most QALYs (0.031 more than etanercept), the cost was an additional €8046 (ICER for infliximab of €260940/QALY vs. etanercept). Results for the HAQ-adjusted life year analysis were similar, where adalimumab (€293/HAQ life year) had similar results in comparison to etanercept (€292/HAQ life year). For years in PASI75 response, etanercept became dominated, golimumab gave 2.308 incremental PASI75 life years at an incremental cost of €29463 (ICER of €12765/PASI75 life year vs. palliative care), adalimumab gave 2.704 incremental PASI75 life years at an incremental cost of €32064 (ICER of €11851/PASI75 life year vs. palliative care), and infliximab became the optimal strategy with 4.407 incremental QALYS at an additional €43553 (ICER of €9883/PASI75 life year vs. palliative care). CONCLUSIONS: Using QALYs, which combine the skin and joint aspects of disease, adalimumab and etanercept were the most cost-effective biologic strategies; infliximab gave marginally more benefit at a much higher cost.