OBJECTIVES To evaluate the cost-effectiveness of certolizumab pegol (CZP) versus other subcutaneous (SC) anti-tumour necrosis factors (anti-TNFs) currently licensed and reimbursed in Romania (etanercept [ETA] and adalimumab [ADA]) in the treatment of adult patients with active rheumatoid arthritis (RA), axial spondyloarthritis (axSpA; comprising ankylosing spondylitis [AS] and non-radiographic axSpA [nr-axSpA]) and psoriatic arthritis (PsA). METHODS Cost-utility models (Markov structure) were developed for each condition, following the EULAR, ASAS and NICE guidelines. Clinical efficacy data, disease history and resource use data came from published literature. Utilities were derived from EQ-5D data assessed in CZP pivotal clinical trials. Published 2013 unit costs were taken from local sources/expert opinion. A willingness-to-pay threshold of 3xGDP/capita (87600RON) was considered. Base-case analysis was conducted from the payer perspective, with lifetime horizon, costs and outcomes discounting rates of 3.5%. Sensitivity analyses were conducted to test the robustness of the results. RESULTS In AS, CZP dominates ADA and ETA (quality-adjusted life years [QALYs] gain of 0,098 and 0,021; total costs lower by 48499.73RON and 8350.28RON, vs ADA and ETA respectively). In nr-axSpA, CZP dominates ADA (QALYs gain of 0,257; total costs lower by 13955.14RON). In RA, CZP dominates ADA (QALY gain of 0,226; total costs lower by 108694RON) and is marginally as effective, but slightly more costly vs ETA (QALYs gain of 0,056, total costs higher by 6356RON). In PsA, CZP dominates ADA (QALY gain of 0.05; total costs lower by 9397RON) and is less costly, but marginally less effective versus ETA (QALYs difference of -0.08, total costs lower by 21484RON). Probabilistic sensitivity analysis indicated that CZP has a similar or higher probability of being cost-effective when compared to comparators. CONCLUSIONS CZP is a cost-effective treatment compared to currently available SC anti-TNFs for the treatment of RA, axSpA and PsA in Romania.