Background. Rheumatoid arthritis is a progressive inflammatory disease that affects greatly patients’ quality of life and demands for aggressive management early on during the course of the disease. The discovery of biologics has equipped rheumatologists with evolutionary treatment tools but has also impacted greatly management costs. Objectives. To conduct a systematic review in order to evaluate the cost effectiveness of abatacept in the treatment of moderate to severe rheumatoid arthritis. Methods. Pubmed, the International Society for Pharmacoeconomics and Outcomes Research Outcomes Research Digest, the National Health System Economic Evaluation Database, and the Database of Abstracts of Reviews of Effects were searched. Results. In total 301 studies were identified and 42？met the inclusion criteria. Half of the selected studies evaluated abatacept in the treatment of rheumatoid arthritis, after failure of or intolerance to tumor necrosis factor alpha inhibitors. Of those, 82% were in favor of abatacept as a cost-effective or dominant strategy versus varying alternatives, whereas 18% favored other treatments. Conclusion. The majority of evidence from the published literature supports that abatacept can be a cost-effective alternative in the treatment of moderate to severe rheumatoid arthritis, especially in patients that have demonstrated inadequate response or intolerance to anti-TNF agents or conventional disease modifying antirheumatic drugs. 1. Introduction Rheumatoid arthritis (RA) is a systemic inflammatory disease that presents itself in multiple joints of the musculoskeletal system. Symptoms include joint swelling, redness, and pain with gradual joint deformity in some cases. Due to its pathophysiology, RA causes not only significant morbidity and progressive loss of quality of life, but also carries a substantial economic burden, both for the individuals as well as for the society as a whole, since it is associated with high intense short- and long-term healthcare resource utilizations due to its increased prevalence and disability potential [1]. Over the last two decades, researchers have equipped rheumatologists with revolutionary therapeutic options. However, these changes have not been fully brought into effect in many European countries and other parts of the world [2, 3]. Disease-modifying antirheumatic drugs (DMARDs) represent the mainstay of RA management. Corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) are also employed, mainly in the short-term, arthritis-related, symptomatic mitigation. Recently, several disease
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