OBJECTIVES: To assess the cost-utility of Tocilizumab (TCZ) in the treatment of methotrexate (MTX)-naïve adults with active rheumatoid arthritis (RA) in Slovakia. METHODS: A decision tree model was developed to reflect the early management of MTX-naïve adult RA patients in Slovakia. Efficacy, DAS28 remission, for each treatment in the model was derived from a network meta-analysis (NMA) of randomised controlled trials (RCTs) [Sawyer et al. 2015]. Benefits were measured in Quality Adjusted Life years (QALYs) derived by mapping DAS28 scores onto EQ-5D utility weights. The analysis was conducted from the third-party payer perspective, and included direct medical costs (drugs, administration, monitoring). The time horizon is one year, in line with the maximum follow-up period from RCTs. Incremental costs and QALYs associated with TCZ±MTX were compared to anti-tumour necrosis factors (TNFs), including adalimumab (ADA), etanercept (ETN) and infliximab (IFX), within their licensed indications. Each treatment was also compared to MTX alone. Variables related to efficacy, cost and utility were tested in the sensitivity analysis. RESULTS: TCZ±MTX had a lower incremental cost-effectiveness ratio (ICER) than other TNFs ±MTX when compared to MTX alone in base case. When compared head-to-head with TNFs, TCZ was cost-effective, with ICERs range from €6,500 to €16,000 per QALY gained in monotherapy and from €10,000 to €24,000 per QALY gained in combination therapy. Furthermore, TCZ+MTX dominated IFX+MTX. The full incremental analysis showed that TCZ±MTX was the next most cost-effective strategy after MTX. Results of the sensitivity analysis showed the efficacy variables and the assumption on the utility mapping formula have an impact on the ICERs. CONCLUSIONS: The results suggest TCZ is a cost-effective alternative to the approved and reimbursed TNFs, used either as monotherapy or in combination with MTX in the treatment of MTX-naïve adult RA patients in Slovakia.