BACKGROUND. Rheumatoid arthritis (RA) is a common autoimmune disease associated with considerable morbidity rates and diminished quality of life. For patients who have an inadequate response to disease-modifying antirheumatic drugs (DMARDs), the use of biologic agents and JAK inhibitor has proved to be effective as second-line treatment. [1]. OBJECTIVES: To evaluate the cost-effectiveness of Tofacitinib as second line treatment vs using the standard  biological therapies as second line treatments in patients with moderate RA after failure of DMARDs in Guatemala Health Care System (IGSS) in 2014. METHODS: A patient-level simulation model was used to evaluate costs and health benefits. This cost-effectiveness model compares two sequences of treatments: one using Tofacitinib as second line treatment followed by biological therapies (Tofacitinib-Infliximab-Adalimumab-Etanercept-Tocilizumab-Rituximab-salvage therapy ) and the other using the same biologic therapies scheme but excluding Tofacitinib; these schemes are defined according to experts opinion from IGSS [2]. All patients received concomitant treatment with methotrexate. Model inputs are: age, weight, initial HAQ score, severe adverse events (SAE) and clinical response to short and long term treatment; randomized controlled trials were used as a source information when local information was not available [3,4]. HAQ scores were used to calculate utilities, measured in QALYs [5,6,7]. Only direct costs were considered using institutional databases from 2014. [8]. Annual discount rate was 5%, the time horizon is to lifetime. RESULTS: Total cost and total QALY per patient in a lifetime period are estimated to be $213,009 and 8.83 QALY for the treatment sequence with Tofacitinib; $222,145 and 8.52 for treatment sequence with biologic therapy only. The cost savings from the treatment sequence with Tofacitinib are 15.2% in the first year, 15.0% in 5 year and 10.7% in ten years. CONCLUSIONS: For the IGSS, the sequence initiating with Tofacitinib is a cost-saving alternative compared with the standard biologic therapy