OBJECTIVES:  A recently published study has evaluated the relative efficacy of adalimumab, apremilast and methotrexate, and their incremental cost per responder (CPR) in the treatment of methotrexate-naïve patients with psoriatic arthritis (PsA) in the United States of America. To the best of our knowledge, the CPRs of these treatments have not been estimated in Spain. This research aims to compare the cost and the CPRs of adalimumab, apremilast and methotrexate in methotrexate-naïve patients with PsA in Spain. METHODS:  The efficacy of the treatments (NNT for achieve a ≥20% improvement in American College of Rheumatology component scores, ACR20) was obtained from a Bayesian network meta-analysis of 3 phase 3 randomized controlled trials (RCT) previously published. The official Spanish prices were considered to calculate the drug costs. Drug costs (in terms of 2016 euros) for 16 weeks were determined based on the dosing regimens of the RCT, and annual costs based on the dosing regimens recommended in the summary of products characteristics. The incremental costs per ACR20 responder were estimated for each of the therapies. RESULTS:  The NNTs relative to placebo were 2.63 for adalimumab, 6.69 for apremilast, and 8.31 for methotrexate. The 16 week costs were €3,628 for adalimumab, €2,597 for apremilast, and €5 for methotrexate. The 16 week incremental costs per ACR20 responder were €9,542 for adalimumab, €17,377 for apremilast, and €38 for methotrexate. The annual costs are €11,791 for adalimumab, €8,430 for apremilast, and €9.5-19 for methotrexate. In clinical practice, these costs may be different because of price changes (e.g., price negotiations with pharmaceutical companies) and changes in the dosing regimens used (e.g., dose tapering). CONCLUSIONS:  According the official Spanish prices, the most efficient treatment (in terms of incremental cost per ACR20 responder) for methotrexate-naïve patients with PsA was methotrexate because of its low price, followed by adalimumab.