The purpose of this study is to estimate economic burden of multiple sclerosis in Georgia and to compare costs of patients with different course of disease and disability level. Hospital-based cohort study was conducted in the P.Sarajishvili Institute of Neurology and Medical Center Pineo to estimate direct medical costs in patients with MS treated between 2019-2020. The mean annual direct medical cost for MS patient on disease-modifying therapies (DMTs) was statistically higher than for non-DMTs patient and estimated as 23254.7Lari[7382.5$] (SD 9026.3; CIs:21133.7-25375.8) versus 1429.1lari [453.6 $] (SD 861.7, CIs; 1309.5-1548.6) (P<0.0001). MS places a huge economic burden on healthcare model and society in Georgia. DMTs are the main driver of cost.