OBJECTIVES: To conduct the cost-effectiveness analysis (CEA) of canakinumab treatment group versus tocilizumab treatment group with systemic juvenile idiopathic arthritis (SJIA).  METHODS: CEA was used to compare canakinumab treatment of patient group with previous inadequate response to tocilizumab versus tocilizumab treatment patient group which was subsequently switched to canakinumab. This analysis based on comparing treatments with usage of American College Rheumatology (ACR) criteria: ACR 30, 50, 70, 90 according to data of real clinical practice that were estimated within one year of therapy. Cost structure included following: drug treatment and administration costs, inpatient and outpatient visits, correction of adverse events and required monitoring laboratory tests. RESULTS: Cost-effectiveness ratios (CER) of tocilizumab and canakinumab treatment group was estimated for ACR 30 as 4,043,444 RUB/66,173 EUR and 15,813,187 RUB/258,791 EUR, respectively; for ACR 50 as 4,043,444 RUB/66,173 EUR and 17,570,208 RUB/287,546 EUR, respectively; for ACR 70 as 7,188,345 RUB/ 117,641 EUR and 19,284,375 RUB/315,599 EUR, respectively; ACR90 as 25,878,040 RUB/ 423,508 EUR and 21,962,760 RUB/359,432 EUR, respectively. CONCLUSIONS: According to results of CEA costs per unit of effectiveness for treatment with canakinumab were higher in most cases. However, CER for ACR 90 as more effectiveness criteria was lower for canakinumab treatment group then in tocilizumab treatment patient group who were subsequently switched on canakinumab. It was determined that treatment with canakinumab was dominant method in comparison with tocilizumab treatment for ACR 90 criteria.