OBJECTIVES: To compare, from the Colombian healthcare system perspective, both costs and effectiveness of tofacitinib with biological therapy as initial treatment in adults with rheumatoid arthritis after failure to methotrexate. METHODS: We used an Excel-based patient level simulation model to compare, with different time horizons (1, 2, 3 , 5, 10, and 20 years), cohorts of patients with tofacitinib as initial therapy compared with adalimumab, certolizumab, etanercept, golimumab or infliximab. All the patients modeled received concomitant treatment with methotrexate. The characteristics of the patients included: age, weight, initial HAQ score, and clinical response to short and long term treatment, based on all available randomized controlled trials (and indirect comparisons, where appropriate). All costs, in 2012 Colombian pesos (1 USD$ = COP$1800) were obtained locally, using official databases for drug costs, and tariff manual (ISS 2001+30%) for procedures and complications. HAQ scores were used to calculate utilities, measured in QALYs. Annual discount rate was 3% both for cost outcomes. RESULTS: Total costs, in million COP$, for the first year of treatment were $25.51 for adalimumab, $26.96 for certolizumab, $26.94 for etanercept, $34.79 for golimumab, $25.63 for infliximab and $22.71 for tofacitinib. Tofacitinib represented a 16% cost reduction over a market-share weighted average of biological therapy in the first year, with equivalent or slightly better QALY gain (0.62 vs. 0.61). Cost savings and utility gained were maintained, and dominance was attained in more than 50% of Monte Carlo trials in the different time horizons and against all comparators considered. CONCLUSIONS: Under our model assumptions, and current costs in Colombia, for the national healthcare system, the sequence initiating with tofacitinib is a cost-saving alternative compared with biological therapy after failure to methotrexate in adults with rheumatoid arthritis, attaining at least the same average effectiveness in all the different time horizons considered.