OBJECTIVES: To evaluate and compare the budget impact of tocilizumab intravenous (IV) and adalimumab subcutaneous as a 1L monotherapy for the 6-month treatment of patients with RA, in the Greek healthcare system METHODS: A budget impact model was developed to evaluate the cost per response rate of the two therapeutic options. Clinical data were derived from a head-to-head trial (ADACTA) and referred to the efficacy endpoints ACR 70, DAS 28≤ 3.2 and DAS 28< 2.6. Cost and resource utilization data were obtained from official government sources (2014) and included the cost of drugs, consumables, human resources, hospital charges and patient’s time (productivity loss). Cost per response for both therapeutic options was estimated for all three clinical endpoints from the hospital, health system and societal perspective.  RESULTS: The difference in cost per response between the alternatives was in favor of tocilizumab in all three scenarios examined. In more detail, the savings generated by the use of tocilizumab associated with achieving ACR 70 for a 68kg (mean weight) patient were €12,529, €9,657 and €8,810 from the hospital, health system and society’s perspective, respectively. Similarly, the savings regarding DAS 28≤ 3.2 were €14,838, €13,041 and €12,506 for each perspective respectively. In the third scenario (DAS 28< 2.6) the difference in cost per response between tocilizumab  and adalimumab was €-32,811 from the hospital’s, €-30,522 from the health system’s and €-29,831 from the society’s perspective. Results indicate that treating  patients with tocilizumab IV yields sufficient savings to initiate  more patients in treatment with tocilizumab in 1L monotherapy and to achieve low disease activity or remission with greater probability and less resources. CONCLUSIONS: Choosing tocilizumab instead of adalimumab as a 1L monotherapy for the RA treatment could be proven to be a cost-saving option, with increased significance in the current economic environment of restricted healthcare resources and significant budget constraints.