OBJECTIVES: This study aimed to assess both direct medical and non-medical costs of Brazilian multiple sclerosis (MS) patients. METHODS: This was a cross-sectional, multicenter study conducted in 8 Brazilian major MS treatment sites. Costs due to MS treatment were calculated based on the resource utilization related to inpatient days, outpatient visits, laboratory and imaging tests, disease modifying therapies (DMTs), co-medication, OTC medications, aids and/or home modifications, and professional caregiver. Unit costs derived from Brazilian official price lists were applied to the yearly frequency and average consumption. RESULTS: The study enrolled 210 MS patients, mean age was 40.7 [standard deviation=11.5] years and 70.7% female. Patients with mild disability (according to self-reported Expanded Disability Status Scale [EDSS]) represented 40.4% of patients, 43.7% had moderate disability and 15.9% had severe disability. The overall yearly direct costs (mean [CI95%]) associated to patients with mild, moderate and severe disabilities were: USD18,475 [2,293-34,657], USD19,371 [4,651-34,090], and USD19,545 [0-57,659] (1BRL = 0.4937USD), respectively. Disease modifying therapies (DMTs) were the major component of the total yearly cost, ranging from 93.5% among mild patients to 53.9% in the severe group (85.5% in the total sample), followed by aids and home modifications (mild: 2.3%; moderate: 2.3%; severe: 15.1%; total sample: 4.3%). Patients with moderate disability had higher absolute costs related to inpatient care, emergency visits, laboratory and imaging tests, and DMTs than the other disability groups, while those with severe disabilities presented higher costs in the remaining categories (consultations, co-medications and OTC medications, aids and home modifications, and professional caregiver). CONCLUSIONS: To our knowledge, this is the first Brazilian study investigating the cost of MS patients. Our findings indicate that MS represent a significant economic burden for both the healthcare system and patients and their families, with different expenditures profiles depending on the EDSS level.