OBJECTIVES:  Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with increasing disability, reduced quality of life and substantial costs. The objective was to estimate the efficacy and treatment costs of two biologic disease-modifying antirheumatic drugs (bDMARDs) in the methotrexate-experienced populations. METHODS:  Data from a previous meta-analyses in RA treatment of methotrexate-experienced patients was used. Pharmacoeconomic comparison between biological agents was carried out to estimate the respective cost for the NNT (number needed to treat) compared to placebo using both American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) criteria. The analysis involved two bDMARDs approved in Italy: tocilizumab (TCZ) and abatacept (ABT), both subcutaneous (sc) and intravenous (iv). A 6-month period was considered sufficient to show the most important differences in efficacy and treatment costs. Direct medical costs, including drugs, administration, and monitoring were considered. The Italian National Health Services (NHS) perspective was considered. RESULTS:  Using both ACR and EULAR criteria, TCZ (iv/sc) had a lower NNT than ABT (iv/sc). The difference in NNT observed for ABT (iv/sc) was more pronounced with EULAR criteria (range: €264-€16,198) than ACR criteria (range: €16,259-€45,874). ABT sc had the lowest treatment cost (€6,399), followed by TCZ sc (€6,888), TCZ iv (€7,131) and ABT iv (€7,343). TCZ sc had the lowest cost for NNT with both ACR and EULAR criteria. Sensitivity analysis confirmed these results. CONCLUSIONS: TCZ (iv/sc) is a cost-effective therapeutic option compared to ABT (iv/sc) in the treatment of methotrexate-experienced patients with rheumatoid arthritis.