OBJECTIVES: Rheumatoid arthritis (RA) critically impair the quality of life of patients. Biologic treatments represent a therapeutic alternative for patients who failed non-biological disease-modifying antirheumatic drugs (DMARDs). Their high cost, however, is a challenge for clinicians and decision makers. The aim of this study was to assess the cost-effectiveness of biologic alternatives to treat RA currently available in China, from a societal perspective.  METHODS: A decision analysis model was developed to simulate the clinical course of patients treated with Infliximab+methotrexate (MTX), Etanercept, Etanercept+MTX, Adalimumab and Adalimumab+MTX as first-line therapies, as well as associated costs over one-year period. Patients were treated for 1-year without discontinuation or switch due to the lack of efficacy or a major adverse event (AE). Effectiveness measures were proportion of patients achieving 20%, 50%, 70% improvement following the American College of Rheumatology (ACR20, ACR50 and ACR70) criteria. Costs included biologics, concomitant drugs, medical follow-up and side effects management. Clinical response of alternatives and administration costs were extracted from published literature, while drug costs were collected from National Development and Reform Commission databases of China.  RESULTS: When compared with Infliximab+MTX, Adalimumab and Adalimumab+MTX, Etanercept is effective over other biologic treatments except in ACR70 2% less effectiveness compared with Infliximab+MTX. Etanercept is 56,179US$ less than Infliximab+MTX (the most costly alternative) and 30% more patients meet the ACR20 criteria regarding Adalimumab (the least effective alternative). When compared with Infliximab+MTX, Adalimumab and Adalimumab+MTX, Etanercept+MTX is dominant over other biologic in either ACR20, ACR50 and ACR70.  CONCLUSIONS: Due to their lower costs and favorable effectiveness profile, Etanercept or Etanercept+MTX are both less costly and the most effective over other biologic treatments in the management of RA in China.