OBJECTIVES: Biologic treatment after systemic drugs fail in psoriasis is indicated for obtaining clinical response. Etanercept effectiveness is not lost in retreatment regimens, which allows continuous or paused therapeutic schemes. The inclusion of etanercept in the private health care system practice represents a breakthrough to psoriasis treatment in Brazil. This study aims to perform cost-effectiveness and cost-utility analysis of biologic alternatives for moderate to severe psoriasis in Brazil, from a private payer’s perspective. METHODS: A decision-tree model simulates psoriasis evolution after treatment with etanercept paused (50mg twice a week for 12 weeks, followed by 25mg twice a week; 12-week treatment cycle and 12-week interruption), adalimumab (80mg at first week, followed by 40mg in the second week, and then 40mg every two weeks) or infliximab (5mg/kg at weeks 0, 2 and 6 and then every 8 weeks) and their associated costs in a 96-week time horizon. Therapy continuation or switch was evaluated at week 24. Effectiveness measures were PASI 75 success rate and quality adjusted life years (QALY) gained. Costs included biologicals, medical follow-up and adverse events management, collected from Brazil private official databases (values represented 2010 USD). Probabilistic sensitivity analyses were performed trough Monte Carlo simulation. A 5% discount rate was applied for costs and benefits. RESULTS: Effectiveness resulted in [PASI 75, QALY] etanercept [51.3%, 1.5360], adalimumab [50.5%, 1.5339] and infliximab [37.2%, 1.5001]. Treatment costs were 90,644USD, 110,663USD and 121,697USD, respectively. Etanercept paused represented the least costly in all comparisons: 20,019USD and 31,054USD less than adalimumab and infliximab, respectively. Acceptability curves showed etanercept paused as the most cost-effective biologic. CONCLUSIONS: In this analysis, etanercept presented the greatest effectiveness in paused therapeutic scheme. Due to its lower costs, etanercept showed to be cost-saving regarding PASI 75 success rate and QALY’s gained over other biologic treatments in psoriasis management at Brazil private healthcare system.