OBJECTIVES: To examine the resource utilization and direct costs of care in severe spondyloarthritis (SpA) patients based on a national representative claims database. METHODS: The EGB Database is a national representative random sample of 1 out of every 97 individuals covered by the main French public health insurance schemes, listing all healthcare consumption and allowing identification of beneficiaries eligible for full health insurance coverage due to severe conditions. The annual economic burden related to severe SpA was estimated by comparing direct medical expenses (outpatient care and hospitalization costs) in the SpA adult (≥18 years) population to a control group (i.e. patients not in “Affection de Longue Durée” for severe SpA in 2012) matched for age and sex, using non-parametric Mann-Whitney tests. Overall cost (healthcare utilization and associated costs) was assessed from the Health Insurance perspective for 2012. RESULTS: Among 470,326 adults in the database, 827 patients presenting with severe SpA were identified, corresponding to a nationwide prevalent population estimate of 88,275 patients in France in 2012. High blood pressure, recurrent major depressive disorders and other comorbidities taken as a whole were significantly more frequent in severe SpA patients than controls (4.5% vs 1.8%, p<0.0001; 3.1% vs 1.5%, p=0.003 and 24.7% vs 18.8%, p=0.0003, respectively). Annual medical costs per severe SpA patient were 3.5 times higher than that of controls (mean costs: €6,122±8,179 vs €1,682±5,769, p< 0.0001; median costs: €2,519 vs €300). The main contributors to this incremental cost were (mean values): medications (+€2,390, 53.8%), hospitalization (+€1,038, 23.4%) and healthcare professional consultations (+€716.7, 16.2%). The annual economic burden related to severe SpA in France in 2012 is estimated around €391M. CONCLUSIONS: The burden of severe SpA is significant in France with regard to comorbidities and medical costs supported by the healthcare system, as identified in this representative database analysis.