Multiple sclerosis (MS) imposes a significant economic burden in low- and middle‐income countries (LMICs). The total costs of the disease increase with disease severity. Costs of MS drugs dominate in less severe disease, whereas the proportion of direct non-medical costs and indirect costs increases with disease severity.

Substantial variations in MS costs were found between studies in LMICs, which made comparison of studies challenging. However, the cost ratios across different levels of MS severity were similar. Therefore, future cost-of-illness (COI) studies of MS in LMICs should include all MS-related cost categories and report on cost per disease severity level as MS costs significantly depend on Expanded Disability Status Scale categories.

COI studies should clearly define the perspective and data sources used. Methodologies adopted to estimate healthcare resource consumption, informal care and productivity losses should be well-defined and in alignment with the country’s own healthcare system and specifications as a marker of the reliability of the COI estimate.