OBJECTIVES: To compare health outcomes and costs associated with a treatment sequence that includes tofacitinib with another treatment sequence without tofacitinib in patients with Rheumatoid Arthritis (RA) who failed to DMARDS from the payer’s perspective of the Ministry of public healthcare in Ecuador.   METHODS: We compared with an Excel-based patient level simulation model, in a lifetime horizon, two treatment sequences, 1) treatment sequence: includes the use of tofacitinib, etanercept, adalimumab, tocilizumab, rituximab and salvage therapy, 2) comparator sequence: includes the use of adalimumab, etanercept, inflximab, tocilizumab, rituximab and salvage therapy. All patients modeled received concomitant treatment with methotrexate. Based on the available randomized controlled trials, HAQ score and clinical response to short and long term treatment data were obtained to calculate utilities, which were measured in QALYs. All costs information 2014 (drug and adverse events) were obtained from public data sources of the Ministry of Public Healthcare in Ecuador.   RESULTS: Total costs in the lifetime horizon of treatment were $199,707.58 USD for the treatment sequence and $213,956.21 USD in the comparator sequence. Incremental costs for drug costs, administration costs, healthcare resources costs and other costs in the treatment sequence were  -$11,881.02 USD, -$213.48 USD, -$460.56 USD and -1,694.60 USD respectively compared with the comparator sequence. Also the treatment sequence showed an incremental QALYs gain of 0.26 compared with the comparator sequence.      CONCLUSIONS: Results suggest that the sequence treatment that includes the use of tofacitinib, represent a cost-saving alternative when compared to the comparator sequence, in patients with Rheumatoid Arthritis (RA) who failed to DMARDS. This may represent savings for the Ministry of Public Healthcare in Ecuador.