OBJECTIVES: Assess the model structure, treatment sequence and outcome in contemporary cost effectiveness analysis (CEA) studies in the US and UK. METHODS: Studies on conventional and biologic Disease-modifying anti-rheumatic drugs (DMARDs) in treating RA patients published from 2008-2013 were reviewed. Various treatment sequences were deemed eligible for patients who had failed DMARDs.  CEA was reviewed from a societal and payers perspective for various patient subgroups and treatment sequences.  RESULTS: Nine studies (5 UK and 4 US) were included from a larger set of 30 CEAs. All UK cost effectiveness studies were based on meta-analysis of RCTs and involved full incremental analysis between comparators. Markov modeling framework or discrete event simulation methods were used with ACR or HAQ as the common effectiveness measure vs. the EULAR criteria. Methotrexate (MTX) was cheapest in moderate or severe RA patients who failed DMARDS. Cost /Quality adjusted life years(QALY) estimated for Etanercept ranged between £24,513 (after failing 2 DMARDS) and £28,380 (failing 2 DMARDS in moderate to severe RA). Cost/QALY of £28,305 for Golimumab (failing 2 DMARDS and 1 TNFi); £18,527 for Rituximab (failing TNFi) and £10,698 for Tocilizumab (Rituximab intolerant, failed DMARDS) were reported. CEA for Abatacept was $43,041 for women with moderate to severe RA who had either failed MTX or $45,979 with failed TNF-α inhibitor. Anakinra followed by non-biological therapy was found cheapest in US (albeit the least effective). CONCLUSIONS: Quality of reporting was good.  Variation in treatment sequence limited direct comparison of estimates between studies.  Seven of nine studies used micro-simulation methods and reported various treatment sequences of DMARDs to be cost effective for subgroup of moderate to severe, bio naïve, DMARD or TNFi failure and women with RA. The hurdle for cost effectiveness is raised when CEA estimates fall below payer thresholds or those of the cheapest alternatives.