OBJECTIVES: Current biologics provide effective clinical benefits to patients with ankylosing spondylitis (AS). We sought to review economic evidence supportive of cost-effective evaluation for currently available biologics developed for treatment of severe AS that aid in disease management decision-making. METHODS: A structured literature search of published and unpublished literature from year 1996-2012 was conducted. We included modeling and other economic studies that assessed cost-effectiveness of biologics and excluded studies evaluating other therapies. RESULTS: Ten studies (infliximab=5, etanercept=2, infliximab and etanercept=1, adalimumab=1, golimumab=1) were analyzed. Majority of studies (N=7) were conducted from societal perspective. Health payer perspective was employed by 2 studies and one study incorporated both. Cohort simulation of patients with severe AS was employed to build cost-effectiveness model by most of the studies and few used patient-level simulation. Non-steroidal anti-inflammatory drugs were considered as comparators in all economic models. Studies employed quality adjusted life years (QALY) as their unit of outcome. Euro-quality-of-life-5 dimensions was used as the instrument for quality weightings by most studies and health utilities index-3 and general health rating scale were used by others. Bath ankylosing spondylitis disease activity index and Bath ankylosing spondylitis functional index were used as response and efficacy parameters. Costs and QALYs discounting rate varied from 3%-6% and 1.5%-5% respectively. Over a longer time horizon (25-40 years), the incremental cost-effectiveness ratio per QALY varied from €7,500-€56,000 for infliximab, €22,000-€32,000 for etanercept, €23,000 for adalimumab, and €30,000 for golimumab. CONCLUSIONS: Although biologics are considered expensive, they are the only approved therapy options for patients with severe AS. Even though existing cost-effectiveness studies have differences in their assumptions and methodologies, they do provide valuable inputs towards building set of disease related parameters useful for economic evaluation of next generation biologic agents.