Canadian clinical and economic data comparing methotrexate and etanercept alone versus etanercept in combination with methotrexate would be necessary before informed predictions could be made on its cost-effectiveness in our health care system. While the direct costs of this therapy are high, if etanercept controls the disease more effectively than current treatments, or earlier in the progression of the disease, it may have incremental cost-effectiveness. In addition, factors such as the timing of initial treatment, adverse effects, and the possibility that anti-TNF therapies may reduce the patient's defense against infection and malignancy, must also be taken into consideration prior to implementation.