OBJECTIVES: To assess the cost-utility of oral fingolimod versus interferon-ß (IFN-ß) treatments (IFN-ß-1a 30mcg, IFN-ß-1a 22mcg, IFN-ß-1a 44mcg and IFN-ß-1b 300mcg) in relapsing-remitting multiple sclerosis (RRMS) patients from the Brazilian Public Healthcare System perspective. METHODS: Cost-effectiveness was evaluated using a Markov model, in 20-years time horizon, comparing fingolimod to IFN-ß treatments. Health states were based on EDSS and relapses, and included separate states for RRMS and Secondary Progressive MS (SPMS). In each yearly cycle, RRMS patients can discontinue treatment; remain stable, progress to higher MS EDSS state, convert from RRMS to SPMS or die. Patients have a fixed annual probability of relapse and death. RRMS patients with EDSS score <7 were eligible for disease modifying therapies (DMTs). Patients with SPMS or EDSS score ≥7 received best supportive care. Transition probabilities were based on natural history of RRMS. Efficacy (i.e. on relapse rates and disability progression) was obtained from a mixed treatment comparison of published results. Health utilities were obtained from Orme et al (2007).  Resources use (physician consultations; ambulatory care; hospitalization, other drugs, services, DMT monitoring and administration) were validated by an experts’ panel and valued using Brazilian official lists. Annual discount rate of 5% was applied both to costs and outcomes. Probabilistic sensitivity analysis (PSA) was performed. RESULTS: Adopting WHO threshold, base case analysis showed fingolimod is more effective and less costly (dominant) versus IFN-ß-1a 44mcg (incremental costs: -26,567BRL; QALY: 0.223) and cost-effectiveness versus IFN-ß-1a 30mcg; IFN-ß-1a 22mcg and IFN-ß-1b 300mcg, with ICER (BRL/QALY): 29,306; 6,725 and 52,626, respectively (<3 GDP/capita or BRL 57,000.00; 1USD = 2.055BRL). PSA has confirmed the consistency of base case results. CONCLUSIONS:  In the treatment of patients with RRMS, fingolimod provides superior effectiveness and represents good value for money in comparison with the most common first line therapies by the healthcare payer in Brazil.