OBJECTIVES: To conduct a cost-per-responder analysis of biologic treatments (adalimumab, etanercept, golimumab, and infliximab) for the treatment of active ankylosing spondylitis (AS) from the German Statutory Health Insurants (SHI) perspective. METHODS: A systematic literature review was conducted to identify randomized clinical trials for biologic treatments for active AS. The clinical efficacy of biologic therapies and standard of care was evaluated using Assessment of SpondyloArthritis international Society (ASAS) 20 response, which is defined as at least 20% improvement from baseline using ASAS criteria. The relative probability of achieving ASAS 20 at Week 12 with each biologic therapy was estimated via network meta-analysis. Evaluation was conducted in terms of cost-per-incremental ASAS 20 responder. Twelve-week costs were assessed in terms of 2012 euros, and included drug acquisition, administration, laboratory tests, and clinic visits based on German treatment guidelines. Weight-based dosing for infliximab assumed an average weight of 78.6 kg. RESULTS: 13 randomized controlled trials of active AS with a minimal duration of 12 weeks were identified; 10 reported ASAS 20 at Week 12. The estimated rates of ASAS 20 response at Week 12 were not statistically different between infliximab (70.8%), adalimumab (62.9%), golimumab (61.2%), and etanercept (60.5%). However, all 4 biologic therapies were significantly better than the standard of care (27.1%). In the base case, adalimumab had the lowest cost-per-incremental ASAS 20 responder compared with standard of care (€13,282 per incremental ASAS 20 responder), followed by golimumab (€13,947), etanercept (€14,221), and infliximab (€22,838). These rankings were unchanged in sensitivity analyses based on ASAS 40 response rates (estimated from 6 trials). CONCLUSIONS: All 4 biologic treatments were more efficacious in terms of ASAS 20 response than the standard of care. Among biologics, adalimumab showed the lowest cost per incremental ASAS 20 responder at Week 12 for active AS from the German SHI perspective.