OBJECTIVES: Assess the cost-effectiveness of first-line tocilizumab biological treatment as monotherapy  or in combination with methotrexate, in patients with rheumatoid arthritis (RA) refractory to treatment with non-biological DMARDs.  METHODS: A markov model was used of the natural history of RA to assess: tocilizumab, tocilizumab+methotrexate, adalimumab, adalimimab+methotrexate, etanercept, etanercept + methotrexate and infliximab+methotrexate. The systematic review of literature don´t show results for infliximab in monotherapy. The strategies were evaluated in combination with methotrexate in the first or second line, for a total of 11 strategies evaluated. Outcomes were measured as quality adjusted life years (QALYs). Analysis from the payer perspective, only direct costs were considered, COP 2012. Ratios were calculated cost-effectiveness and incremental cost-effectiveness, and sensitivity analyzes deterministic and probabilistic were conducted. For the RA chronicity, was used time horizon until life expectancy used discount rate of 3% for both costs and health outcomes. RESULTS: Tocilizumab was one of the least expensive strategy in first and second-line treatment. For life expectancy horizon monotherapy with tocilizumab followed by infliximab in second line are efficient frontier with an ICER per QALY gained of COP $165,918,610.58. The ICER is sensible to price of medicaments, with a inferiority limit, the results change to COP $106.160.64. The probabilistic analysis indicates that a threshold to willingness to pay of COP $ 150 million higher than monotherapy with tocilizumab, be cost-effective in Colombia. CONCLUSIONS: The use of tocilizumab in first and second line like monotherapy and in combination strategy remains lower costs per benefit gained; in that sense, can be considered as an efficient therapy in the Colombian context.