BACKGROUND: Rheumatoid Arthritis (RA), a chronic systemic inflammatory disorder, affects around 0.5% of the Brazilian population. In the Brazilian Public Health System (SUS), the current standard of care is disease-modifying antirheumatic drugs (DMARDs), which can be synthetic (sDMARD) or biologic (bDMARD). However, the toxicity of sDMARD can influence the physician choice toward DMARD monotherapy. Three bDMARDs are available in SUS to treat RA in the first-line: adalimumab, etanercept, certolizumab (anti-TNFs). Adalimumab and etanercept represent almost 90% of actual market share in SUS. However, when used in monotherapy, outcomes with anti-TNF are generally not as efficacious as when used in combination with methotrexate and patients must switch to an alternative treatment. OBJECTIVES:  This study aims to evaluate the budget impact of tocilizumab inclusion in SUS for the RA patients intolerant/contraindicated to sDMARD. METHODS:  The annual treatment cost of adalimumab, certolizumab, etanercept and tocilizumab were compared, considering only drugs acquisition cost. Prevalence estimates were obtained from national literature, with market share evidence for the different bDMARDs sourced using real world data from the Public Database (DATASUS). Base scenario was outlined maintaining the current share of biologic drugs in government purchases and the alternative scenario considered the growth of certolizumab. A univariate sensitivity analysis was conducted varying epidemiological and treatment parameters. RESULTS:  Different scenarios were considered and the budget impact analysis highlights the ability of tocilizumab to provide savings to the Public Health System. In five years, savings can reach up to 11% of current SUS first-line RA budget. The sensitivity analysis showed consistency in the model. CONCLUSIONS:  Tocilizumab has already shown in a head-to-head study superiority over adalimumab as a biologic monotherapy first-line treatment, this economic analysis shows in addition it would offer cost-savings to the SUS. We can conclude tocilizumab represents not only the most effective monotherapy treatment, but also a cost-effective therapy.