OBJECTIVES: New BA offer more therapeutic options to control psoriasis symptoms but add to the already considerable cost of managing psoriasis. Expert panels have published guidelines for the use of BA although few of them considered the treatment options cost-effectiveness. The Brazilian expert guidelines, however, considered. We present a Brazilian cost effectiveness model based on micro-simulation. METHODS: Our cost effectiveness model simulates the real-life Brazilian treatment sequence (acitretin, methotrexate, cyclosporine, BA) for 1,000 patients based on the average time of use of each drug (10.74, 6.56, 24.00, and 30.00 months, respectively). Three different BA, adalimumab, eternacept and infliximab, were analyzed. Cost effectiveness was calculated in terms of the number of patients that achieve PASI 75 response with each BA. The base case was a moderate-to-severe psoriasis patient, with at least 10% BSA affected, PASI score of at least 12, without infection in the lesions and eligible for systemic therapy. Time of use of each drug in Brazil came from a previous Brazilian study and the PASI score from major studies with each drug from the medical literature. The local disease management and costs were based on a Delphi panel according to the private healthcare perspective. Outcomes were discounted at 3% annually. RESULTS: In order that all patients pass all the four treatment lines it took an average time of 71.3 months; the Brazilian treatment sequence added to fortnightly adalimumab, weekly adalimumab, infliximab and eternacept, respectively, generated 529, 799, 879 and 490 patients achieving PASI 75 and also, respectively, generated R$ 129,071,880.38, R$ 257,708,724.48, R$ 132,251,142.76, R$ 342,274,532.45 total costs. CONCLUSION: The Brazilian treatment sequence added to infliximab is a dominant alternative in relation to that added to weekly adalimumab and eternacept. It also has an acceptable cost-effectiveness ratio in Brazil in relation to fortnightly adalimumab (R$9,092.70).