OBJECTIVES: To assess the cost-effectiveness of tocilizumab and TNF-alfa inhibitors in the treatment of Russian patients with rheumatoid arthritis (RA) and intolerance or inadequate response to disease-modifying antirheumatic drugs (DMARDs) or for whom continuation of DMARDs was deemed inappropriate. METHODS: Based on the data from ADACTA-trial and the results of indirect comparison of tocilizumab and anti-TNF-alfa agents (G. Bergman et al., 2010) two pharmacoeconomic models were developed. A six-month time horizon was adopted in the models. Cost-effectiveness of tocilizumab and adalimumab was estimated in the first model. In the second model, cost-effectiveness of tocilizumab was compared to the cost-effectiveness of antirheumatic therapy in the mixed treatment group, which included patients who received infliximab, etanercept and adalimumab in proportion 1:1:1. The cost analysis included costs of medicines and expenses for the day care services. The efficacy of the treatment was defined as a DAS28-reduction, proportion of patients achieved a low or moderate DAS28, EULAR good or moderate response (was considered only in the first model) and ACR20, ACR50, ACR70 responses. Sensitivity analysis (SA) was performed by changing costs of medicines and relative proportions of patients received infliximab, etanercept and adalimumab in the mixed treatment group.  RESULTS: Despite the higher cost of treatment with tocilizumab (591,112.92 RUB as compared to 488,735.00 RUB for adalimumab), it had the better cost-effectiveness ratios (CERs): 179,125.04 RUB vs 271,519.44 RUB per unit of DAS28-reduction, respectively. The similar results were observed for the CERs estimated per one patient with clinical response. Compared to the mixed treatment group, tocilizumab also had better CERs. SA confirmed the robustness of the model. CONCLUSIONS: The study has demonstrated that tocilizumab is an economically effective strategy in the treatment of Russian patients with RA and intolerance or inadequate response to DMARDs or for whom continuation of DMARDs was deemed inappropriate.