OBJECTIVES: Psoriasis is a systemic inflammatory chronic disease with increasing morbidity worldwide. Psoriasis is associated with many comorbidities such as diabetes and obesity. In the last years, treatment options have been based on biologic therapies to reduce symptoms, improve quality of life and reduce disease progression. Biologic drugs have played a major role in reducing the management and complications costs in psoriasis therapy. The goal of this study was to evaluate the costs-effectiveness of three psoriasis biologic therapies used in a large general hospital in Ecuador. METHODS: The study evaluated during a 24-week period the efficacy of three biologic therapies for psoriasis management used a large public hospital in Quito, Ecuador, namely adalimumab (40 mg/subcutaneously, every other week), etanercept (dose 50 mg/subcutaneously, weekly), and infliximab (dose 3 mg/kg intravenously every 8 weeks). Efficacy was defined by a Psoriasis Area Severity Index (PASI) of 75 or 90 and by the Patient Global disease Activity (PGA). Treatment and management costs of the disease were calculated from the local database and from the Ecuadorian Reference Costs (2014) manual. Sensitivity analysis was performed by Monte-Carlo simulations. RESULTS: In terms of cost per patient and PASI 75 improvements, adalimumab was also the most cost–effective biologic agent with a costs/patient amount of 4,396.16 USD followed by infliximab with 6,635.94 USD and finally etanercept 7,469.65 USD. When considering PGA/01 evaluation, adalimumab was the most cost-effective biologic therapy with an amount of 12,324.95 USD, followed by infliximab (36,752 USD) and etanercept (126,984 USD). CONCLUSIONS: Adalimumab, followed by infliximab, were the most cost-effective biologic agents in psoriasis management based on PASI 75 improvements. For PGA/01, adalimumab was also optimal followed by infliximab