OBJECTIVES: To estimate the cost per responder (CPR) associated with biological therapy versus placebo in the treatment of RA from the perspective of the Brazilian Public Health System (SUS). METHODS: A literature search was conducted to identify indirect comparisons between abatacept, adalimumab, certolizumab, golimumab, etanercept, infliximab, tocilizumab and tofacitinib in the treatment of RA, considering the percentage of responders based on ACR50 (50% improvement in the number of painful and swollen joints) as the outcome. The CPR analysis was based on the efficacy and the drug acquisition costs necessary for 24 weeks of treatment. The efficacy was expressed as number needed to treat (NNT) to achieve clinical response in terms of ACR50 for a patient, in comparison to placebo. Treatments costs data were taken from the Brazilian Ministry of Health’s published prices in 2016. Sensitivity analyses were performed and have tested alternative NNT of biological drugs and evaluated only the drug’s maintenance doses. RESULTS: According to inclusion criteria of the literature search, two systematic reviews were considered to extract the efficacies data. Drugs with the lowest NNT for improvement in the ACR50 outcome were tofacitinib (NNT = 4,61), Abatacept (NNT = 6,23) and golimumab (NNT = 8,61), respectively. Drugs presenting the lowest CPR were tofacitinib (BRL 25,176), abatacept (BRL 51,402), and infliximab (BRL 55,608). In the sensitivity analysis evaluating maintenance doses, the three drugs remained as the ones presenting the lowest CPR. However, NNT was changed; etanercept, adalimumab and tocilizumab presented the lowest values of CPR, respectively. CONCLUSIONS: Tofacitinib, abatacept and infliximab are likely to present the lowest costs per responder in 24 weeks of treatment in SUS when ACR50 is the targeted outcome. More thorough researches are needed to assess whether such CPRs are maintained in the long-term treatment.