OBJECTIVES About 2.79% of patientswith rheumatoid arthritis (RA) in Russia receive TNF-α inhibitors; this value may vary significantly and depends on limitations of regional budgets. In this respect, the aim of our study was to conduct a comparative pharmacoeconomic analysis of the most prevalent TNF-α inhibitors in Russian patients with rheumatoid arthritis and intolerance or inadequate response to conventional basic therapy. METHODS An pharmacoeconomic model was developed based on the data from indirect comparison of anti-TNF-α agents. The model considers the use of infliximab, etanercept, certulizumab pegol, adalimumab in patients with RA who lost response to conventional basic therapy. Cost-effectiveness and costs of TNF-α inhibitors for health care budget were estimated. The cost analysis included costs of pharmacotherapy. Infliximab and etanercept are included into the list of vital and essential medicines and were considered as accepted technologies in budget impact analysis: certulizumab pegol and adalimumab were novel tecnologies in our model. A 24-weeks horizon was adopted. Sensitivity analysis (SA) was performed by changing costs of medicines  RESULTS the costs of therapy in certulizumab pegol and etanercept groups were significantly lower than in infliximab and adalimumab groups. The cost-effectiveness ratios (CERs) in terms of ACR20 in 24 weeks were 703 625.00, 587 776.09, and 4 119 260.82 for certulizumab pegol, etanercept and infliximab groups, respectively. The same was observed in case of ACR50 and ACR70: a strategy of drug use in certulizumab pegol and etanercept groups was preferable in comparison with infliximab and adalimumab groups. Budgetary costs for health care system were higher in case of infliximab and adalimumab. SA confirmed the robustness of the model CONCLUSIONS The study demonstrated that certulizumab pegol and etanercept are an economically effective strategy for Russian patients with RA and lost response to conventional basic therapy.