OBJECTIVES The purpose of present study was to evaluate the cost-effectiveness of tocilizumab(TCZ) vs. infliximab(IFX)  for the treatment of patients with rheumatoid arthritis(RA) from the perspective of Ministry of Health(MoH) over a patient lifetime horizon in Kazakhstan.  METHODS A decision analytic model was constructed in MS-Excel to estimate effects and directs costs of methotrexate(MTX) combination with TCZ or IFX in hypothetical cohorts of RA patients. Treatment efficacy and transition probabilities were synthesized through a meta-analysis of data from relevant clinical trials and literature. The characteristics of patient cohort and treatment costs (drug, monitoring, RA-related hospitalisation, adverse effects management) in year 2014 Kazakhstani tenge(KZT) were estimated from republican official sources. Primary efficacy outcome was defined as an improvement of 70% in ACR response(ACR70), which can be regarded as a close measure of remission. Annual 3% discounting rate and 6-month cycles were utilized for the model.  Robustness of the model parameters was explored by one-way and probabilistic sensitivity analysis. RESULTS For an average 70-kg patient, discounted direct costs per year were estimated at 4 456 000 KZT for TCZ+MTX and 3 190 000 KZT for IFX+MTX. Adjusted ACR70 rates were higher in TCZ+MTX group(23%) than in IFX+MTX group(17%). As a result of a lifetime stimulation (average 12 years) of the model, TCZ incurred 1.89 times higher costs, and 1.67 times more achievements of ACR70 than IFX. The ICER was estimated to be 3 218 900 KZT per achieved ACR70, which is within the cost-effectiveness threshold values recommended by WHO. Overall, model was sensitive to the changes in drug costs and patient weight.  CONCLUSIONS TCZ+MTX incurred significantly higher costs compared to IFX+MTX, although ICER per achieved ACR70 lays within the recommendations of WHO. Further research is necessary for other ACR rates. These findings may better inform decision makers regarding formulary inclusion and reimbursement in the treatment of RA patients in Kazakhstan.