OBJECTIVES: To assess the cost-effectiveness ratio of tofacitinib when compared to alternative treatment strategies currently available for moderate to severe rheumatoid arthritis (RA) from the perspective of the Brazilian healthcare system. METHODS: A patient-level microsimulation model with a six-month length has been developed to measure the lifetime cost and quality-adjusted life-years (QALY) associated with RA treatment and disease progression. Patients’ outcome ranged based on the HAQ score. In the model, only severe adverse events were taken into consideration. The model compared treatment sequence with tofacitinibe with a comparator sequence without tofacitinibe in the patient care pathway following the 2014 Brazilian Therapeutic Guidelines for RA. The costs related to drug treatment and to patient follow-up were taken into consideration. For such, the list price published by the Brazilian agency was used. Monitoring standards were defined by specialists and funded by using the list of procedures, orthoses, and prostheses from SUS [Brazilian Unified Health System] (SIGTAP) and the website for healthcare information (TABNET) from the Ministry of Health. The probability sensitivity analysis was calculated having 50 first-order iterations and 500 second-order iterations, thus yielding a total of 25,000 iterations. An amount of BRL 81,667 was adopted as a limit of willingness to pay – equivalent to three times the national GDP per capita (2014). RESULTS: In all scenarios, the treatment arm including tofacitinibe was shown to be dominant with lower costs and greater effectiveness – saving up to BRL 77,271.97. The probability sensitivity analysis (PSA) was also completed showing that tofacitinibe likely to be 52% more effective, 92% more economical and 87% more cost-effective for one of the scenarios. CONCLUSIONS: The inclusion of tofacitinibe into the treatment strategy for moderate to severe RA is a dominant strategy for Brazilian healthcare system. These results were shown to be robust after completing PSA.