OBJECTIVES: Until 2010 the cost of biological treatments in Rheumatoid Arthritis (RA) was increased annually by 15% in our hospital. In 1stJanuary 2011, a Hospital Commission and Protocol of Biological Therapies were created to improve the cost-effectiveness usage of biological drugs in RA.  To evaluate the economic impact associated with a biological therapy prioritization Protocol for RA patients in the Hospital of Sagunto. METHODS: Observational, ambispective study comparing the associated cost of biotreated RA patients pre-protocol (2009-2010) versus post-protocol periods (2011-2012). Inclusion criteria: RA patients treated with Abatacept (ABA) Adalimumab (ADA), Etanercept (ETN) or Infliximab (IFX) for at least 6 months during the study period (2009-2012).  ETN was selected as 1st line therapy because our successful experience of ETN 25 mg/weekly in certain RA patients, its subcutaneous administration and lowest theoretical cost per patient in Spain. Cost savings and economic impact were calculated using Spanish official prices. RESULTS: In the pre-protocol period (2009-2010), total expenses were increased by 110,000€, up to 1,761,000€ in 2010 (11,362€ pat/year). After protocol implementation, total expenses decreased by 53,676€ on the 2010-2011 period, and 149,200€ on the 2011-2012 period. On the 2010-2011 period the cost of biological therapy per patient-year decreased 355€ (11,007€ pat/year) and additional 653€ (up to 10,354€ pat/year) by 2012, with a cumulative effect of the protocol implementation of 1,008€ per patient-year. In the pre-protocol period, the annual cost/patient was 10.812€ with ETN, 10.942€ with IFX, 12.961€ with ADA and 12.739€ with ABA. By 1st Jan 2013, the annual cost per patient was 9,469€ with ETN, 10,579€ with IFX, 11,117€ with ADA and 13,540€ with ABA. CONCLUSIONS: The creation of our Commission of Biological Therapies is key to rational management of RA patients and optimization of resources, allowing us to save 200,000€ after 2-year efficiency protocol implementation.