OBJECTIVES: Available DMTs in multiple sclerosis (MS) differ regarding monitoring requirements. The aim of this research was to assess monitoring cost differences for glatiramer acetate (GA) and other DMTs in the UK, France, Spain, Germany, Italy, and US. METHODS: Monitoring requirements for GA, teriflunomide, interferon beta-1a, fingolimod (FG), natalizumab, dimethyl fumarate (DF), and alemtuzumab were obtained from EMA and FDA labels. Required monitoring unit costs were obtained from publicly available sources for each country in scope (EU5 and US). An analysis with different time horizons (1, 3, and 5 years) was conducted to determine relative monitoring costs. RESULTS: Common monitoring tests include liver and thyroid function, blood cell count, magnetic resonance imaging (MRI), and serum creatinine. Based on 1-year data, DMTs with the two lowest and highest monitoring costs in the US were DF ($396), GA ($426), natalizumab ($1183), alemtuzumab ($1316); in Spain GA (118€), DF ($152), natalizumab (502€), alemtuzumab (998€); in Italy DF (47€), GA (61€), natalizumab (213€), alemtuzumab (348€); in France GA (98€), DF (102€), FG (323€), alemtuzumab (819€); in UK DF (£317), GA (£354), FG (£560), alemtuzumab (£662); in Germany GA (58€), DF (59€), natalizumab (222€), alemtuzumab (474€). Physician consultation fees are an important cost driver, especially in the UK and US where the cost of a specialist visit is higher versus other countries. In France, Spain, Germany, and Italy, visits to specialists are less expensive; thus, test costs have a bigger impact on the overall monitoring costs. These trends were confirmed by 3-year and 5-year data. CONCLUSIONS: Monitoring cost of GA is low compared to biologic drugs that require either expensive annual examinations such as MRI (natalizumab) or frequent laboratory tests (alemtuzumab). Differences in monitoring costs should be included in the overall economic evaluation of DMTs in MS.