Comparative studies of healthcare utilization and costs among multiple sclerosis (MS) disease-modifying therapies (DMTs) are limited.

In this study, we compared healthcare expenditure and utilization across DMTs in a commercially insured MS population in the USA during 2010–2019.

People with MS treated with both high- and standard-efficacy DMTs had significantly more overall outpatient doctor visits, neurology visits, MS-related brain and spine MRIs as well as occurrences of relapses and medical complexities than the untreated.

Both the high- and standard-efficacy DMT treatment groups had higher pharmacy costs and overall healthcare costs than the untreated group, despite having lower or equivalent non-pharmacy medical costs.

DMT cost is an important driver of healthcare expenditure in MS.