OBJECTIVES: Patients with rheumatoid arthritis in Taiwan might receive lifelong reimbursement for biologics from the Bureau of National Health Insurance (BNHI) if they satisfied required criteria, which might have a significant impact on the annual budgets of the BNHI. The objective of this study was to analyze and compare the cost-effectiveness among existing reimbursed eleven possible combinations of biological treatment strategies, while under limited and lifelong treatment duration assumptions. METHODS: Under limited and lifelong treatment duration assumptions, Monte-Carlo simulation was used to compare the cost-effectiveness of eleven possible combinations of biological treatment (Adalimumab, Etanercept, and Rituximab) strategies in patients with active RA. Treatment duration assumptions, effectiveness and utility parameters for different biological treatment strategies were obtained from published papers. Direct medical and drug costs were estimated according to Taiwan's National Health Insurance fee schedule for 2011 and the National Health Insurance payment standard. Probability sensitivity analysis was applied after Monte-Carlo simulation. Incremental costs per quality-adjusted life-year (QALY) between the strategies were calculated. Both cost and effectiveness were discounted at the rate of 3.5%. RESULTS: There were differences between the results for limited and lifelong treatment duration assumptions. For limited treatment duration, stratagies with Adalimumab as the first line biologic (including Adalimumab only; Adalimumab followed by Rituximab; Adalimumab, Rituximab and Etanercept; Adalimumab, Etanercept and Rituximab; Etanercept, Adalimumab and Rituximab) were more cost-effective. For lifelong treatment duration, however, strategies with Etanercept as the first line biologic (including Etanercept only; Etanercept followed by Rituximab; Etanercept, Rituximab and Adalimumab; Etanercept, Adalimumab and Rituximab) were more cost-effective. CONCLUSIONS: From the Bureau of National Health Insurance point of view, there seems to be a difference in defining the more cost-effective strategy under the assumptions, however, the strategy using Etanercept as the first line biologic followed by Adalimumab and Rituximab was cost-effective under both assumptions.