Objectives:To estimate the cost of illness, quality of life and work productivity in patients with Axial Spondyloarthritis (Axial SpA) under biological treatment in Greece.Methods:We conducted a prospective study of 12-month duration, of patients with Axial SpA from a tertiary hospital in Greece. Adult patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) criteria were enrolled at the beginning of biological treatment due to active disease [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) >4] and failure of first line treatment. All participants completed questionnaires about quality of life, financial costs and work productivity at the same time with the disease activity assessment.Results:74 patients of whom 57 (77%) with a paid job, were included in the study. The total annual cost for Axial SpA patients is € 9,012.40 while the average cost of acquisition and administration of the drugs is € 8,364. The mean BASDAI in the 52 weeks of follow-up, was decreased from 5.74 to 3.2 and the mean Health Assessment Questionnaire (HAQ) also from 1.13 to 0.75. Work productivity of these patients as measured with the Work Productivity and Activity Impairment Questionnaire (WPAI), was significantly impaired at the baseline and improved after the initiation of biological treatment.Conclusions:The cost of illness in patients receiving biological treatments in Greece is high. However, these treatments except from the well-established positive effect on disease activity, can improve remarkably the work productivity and quality of life of Axial SpA patients.