OBJECTIVES:  To evaluate the cost-utility of ustekinumab in moderate to severe psoriasis compared with the use of infliximab, adalimumab, etanercept and secukinumab. METHODS:  A Markov model from a third-party payer’s perspective was performed, using quality-adjusted life-years (QALYs) as the final outcome measure, which was modelled through Psoriasis Area Severity Index (PASI) 50, 75 and 90. The model timeframe was ten years with a 5% discount rate. The comparators were selected by conducting a modified Delphi panel of experts. Only direct medical costs were considered: cost of first biologic and treatment with a second biologic after failure or non-response to initial medication (failure was an absorbing state and its cost was an average of all other biologics besides the starting biologic). A probabilistic sensitivity analysis on prices and key variables of the model was also performed. RESULTS:  The total discounted costs of treatment per patient for a 10-year period were (USD): ustekinumab $37,682; infliximab $49,434; adalimumab $44,363; etanercept 50 mg $49,017, etanercept 25mg $48 828; and secukinumab $52,456 (Exchange rate: 1 USD = COP $3,000). The model estimated QALYs associated with increases in utility based on the PASI response achieved by each comparator during each weekly cycle. The accumulated QALYs after the ten year period were: 6.11, 4.20, 5.69, 5.41, 5.30 and 5.61 with ustekinumab 45mg/90mg for patients with body weight over 100 kilos, infliximab 5mg/kg, adalimumab 40mg, etanercept 50mg, etanercept 25mg and secukinumab 300mg, respectively. Shorter time on treatment with first biologic implied lower QALYs. The cost utility analysis of ustekinumab compared to all alternatives resulted in more QALYs to patients at the lowest cost. CONCLUSIONS: The results show that the use of ustekinumab is the alternative that added more QALYs to patients at the lowest cost in the long term in comparison to the use of any anti-TNF or anti-IL 17.