Rheumatoid Arthrtis (RA) leads to significant impact on management costs and patient's quality of life if no therapeutic measure is adopted and represents one of five most common incapacity causes in women aged 15-44 years, in Colombia. Biologic treatment after disease-modifying antirheumatic drugs fail is an alternative, but their high cost represents a challenge for decision makers. This study aims to perform cost-effectiveness and cost-utility analysis of biologic alternatives for moderate to severe RA in Colombia, from a public perspective. An economic analysis was developed through a decision-tree model to simulate RA evolution after treatment with etanercept (basecase treatment), adalimumab or infliximab as first-line therapies and their associated costs over a 12-month time horizon. Therapy continuation or switch was evaluated at week 24. Effectiveness measures were ACR70 response and quality adjusted life years (QALYs) gained. Direct medical costs included biologics, concomitant drugs, medical follow-up and adverse events management. Clinical response was extracted from published literature, while costs were collected from Colombian public official databases. Probabilistic sensitivity analyses were performed through Monte Carlo Simulation second-order approach. In base case analysis estimated effectiveness resulted in [ACR70, QALY]: etanercept [31.3%, 0.79]; adalimumab [18.1%, 0.77] and infliximab [12.8%, 0.73]. Expected mean costs per patient were 23,065USD, 24,869USD and 25,853USD, respectively. In cost-effectiveness and cost-utility analysis, etanercept was the less costly and the most effective alternative being cost-saving in all comparisons: 2789USD less than infliximab(most costly alternative); 18.5% more patients met ACR70 response regarding infliximab(the least effective alternatives); incremental utility reached -0.0576 versus infliximab. Acceptability curves showed that etanercept regardless willingness to pay would be the most cost-effective biologic. Due to its lower costs and favorable effectiveness profile, etanercept is dominant regarding ACR70 response and QALYs gained over other biologic treatments in the management of RA at Colombian public health care system.