OBJECTIVES: In a randomized, double blind, controlled phase IV trial (ADACTA)*,Tocilizumab (TCZ) demonstrated  superiority vs Adalimumab (ADA) in monotherapy, reducing signs and symptoms of rheumatoid arthritis (RA) in patients by whom methotrexate (MTX) is not tolerated or for whom it is inappropriate.The aim of this analysis was to evaluate the cost per response and the cost per disease remission of TCZ vs ADA in an RA monotherapy setting from the Italian Hospital perspective. METHODS: TCZ-IV (intra-venous-8mg/kg monthly) and ADA-SC (subcutaneous-40mgQ2W) monotherapy  were compared, using efficacy results from ADACTA trial, in terms of cost per response (American College of Rheumatology-ACR20-50-70) and cost per remission for both Disease-Activity-Score (DAS28<2.6) and Clinical-Disease-Activity-Index (CDAI≤2.8). Treatment costs were considered (drug acquisition, administration and monitoring), obtained from published sources. Drug acquisition cost was derived from the ex-factory price. Drug administration cost (TCZ-IV only) was based on the cost for nursing and medical staff required for each infusion; monitoring visits and tests were considered as one per month for TCZ-IV and one every three months for ADA-SC.The analysis was conducted from the Hospital perspective and the time horizon was 24 weeks.  RESULTS: Compared with ADA, TCZ resulted dominant (more effective and less costly). The cost per response was lower with TCZ than with ADA: ACR20: €10,494.5 and €12,533.4;ACR50: €14,452.2 vs €22,271.5;ACR70: €20,989.1 and €34,589.3 respectively. The cost per remission was €17,096.4 vs €58,966.6 for DAS28<2.6 and €39,659.6 vs €66,575.2 for CDAI≤2.8 for TCZ vs ADA respectively. CONCLUSIONS: According to this analysis, in Italy TCZ monotherapy can be considered as an efficient strategy compared to ADA for treating RA patients intolerant to MTX or for whom MTX is inappropriate. *Gabay C,Emery P,van Vollenhoven R,Dikranian A,Alten R,Pavelka K,Klearman M,Musselman D,Agarwal S,Green J,Kavanaugh A; ADACTA Study Investigators.Tocilizumab monotherapy versus adalimumab monotherapy for treatment of rheumatoid arthritis (ADACTA):a randomised,double-blind,controlled phase 4 trial. Lancet 2013;381(9877):1541-50