OBJECTIVES: to perform economic evaluation of adalimumab + methotrexate vs rituximab + methotrexate and infliximab + methotrexate in patients with rheumatoid arthritis resistant to traditional methods of treatment in Russian health care system. METHODS: the modeled study was performed. Data on dosing regimen, efficacy and safety of biologics were extracted from studies ARMADA, DANCER, and ATTRACT. Effect was measured in proportion of patients receiving this combination achieved ACR 20/50/70. Cost of treatment with biologics combined with methotrexate for 24 weeks and cost-effectiveness ratio (CER) were calculated from the Russian reimbursement system point of view. RESULTS: adalimumab is more effective in patients achieved ACR 20 (67, 54, and 50% of patients receiving adalimumab, rituximab, and infliximab accordingly achieved ACR 20), ACR 50 (55, 34, and 27% accordingly), and it is more effective that infliximab and has nearly equal efficacy with rituximab in patients achieved ACR 70 (27, 30, and 8% accordingly). The cost of treatment was 682,229.06 rubles for adalimumab + methotrexate, 651,876.66 rubles for infliximab + methotrexate, and 472,906.20 rubles for rituximab + methotrexate. CER for effectiveness criteria “achieving ACR 20” for adalimumab was 1,018,252.33. It was lower than for infliximab (1,303,753.32), but higher than for rituximab (875,752.22). CER for effectiveness criteria “achieving ACR 50” was 1,240,416.47, 1,390,900.59, and 2,414,358.00 accordingly, and CER for “achieving ACR 70” was 2,526,774.30, 2,364,531.00, and 8,148,458.25 accordingly. Incremental CER for adalimumab was 1,610,175.85 / 996,775.52 / 2,990,326.57 rubles for one patient achieved ACR 20/50/70 compared to rituximab. CONCLUSIONS: adalimumab, used as first line of therapy with biological drugs, is more economically effective in patients with rheumatoid arthritis resistant to standard therapy, than infliximab. Rituximab seems to be more economically effective alternative drug but it can be used only as second or third line of treatment with biological drugs according to Russian standards of rheumatoid arthritis’ management.