OBJECTIVES: Rheumatoid arthritis is an autoimmune chronic disease which is associated with an increasing disability of patients and high socioeconomic burden. Given the large number of economic evaluations considered by national HTAs, this review attempts to clarify whether biologic DMARDs cost-effectiveness and cost-utility results form the basis for official recommendation by national HTA agencies.  METHODS: Both older biologic anti-TNFα drugs (etanercept, infliximab and adalimumab) and novel bDMARDs (abatacept, tocilizumab, certolizumab, golimumab and rituximab) were considered. All main HTA agencies were searched for published economic evaluations up to 2012. Documents were selected if they included cost-effectiveness or cost-utility as outcome, if they referred to at least one of the drugs of interest, if they were published in English and if they were not superseded by other analysis. PICO statements were used to define exclusion criteria.  RESULTS: Of the 65 documents initially identified through the search strategy, 20 documents were selected. The associated HTA agencies were PBAC (Australia), CADTH (Canada), SMC (Scotland) and NICE (England). In relation to older anti-TNFα, documents published by NICE were found to be the only explicitly recommending the drugs on the basis of obtained cost-utility results. Economic evaluations of novel bDMARDs published by SMC and NICE appeared to inform HTA decisions not to recommend abatacept and to list all other drugs conditional on price facilitation and following failure of rituximab. By contrast, cost-utility analysis published by PBAC and CADTH did not appear to influence official recommendations on novel biologic DMARDs.  CONCLUSIONS: Cost-effectiveness and cost-utility evidence was not equally perceived by decision-makers and did not have equal weight in defining the official listing of biologic DMARDs for the treatment of RA. Further research should therefore address methods for a greater integration between health economic analysis and final decisions taken by National HTA agencies.