Introducion: Multiple Sclerosis (MS) is a chronic, inflammatory disease affecting the central nervous system. Although primarily managed in outpatient settings, MS may lead to costly hospitalizations. While hospital mortality associated with MS is uncommon in high-income countries, its impact within developing healthcare systems remains insufficiently studied. This study aims to describe the clinical and economic implications of MS-related hospitalizations in Brazil.

Methods: A descriptive ecological study was conducted using data from the Brazilian Unified Health System Hospital Information System (SIH/SUS). All hospital admissions registered under ICD-10 code G35 (MS) between July 2015 and July 2025 were included. The variables analyzed comprised the number of hospitalizations, in-hospital deaths, length of stay, associated costs, and regional distribution across the country.

Results: A total of 9,482 hospitalizations for Multiple Sclerosis were recorded, amounting to 92,415 hospital days. There were 245 in-hospital deaths, resulting in a mean case fatality rate of 2.6% (ranging from 1.7% to 3.2%). The average length of stay was 9.7 days. Cumulative hospital expenditures reached R$ 24.8 million (approximately USD 5 million), with an average cost of R$ 2,600 per admission—exceeding R$ 3,000 in certain years. Regionally, the Southeast accounted for 43% of all hospitalizations and the South for 25%, whereas the North and Northeast regions showed proportionally higher mortality rates (>3%).

Conclusion: From 2015 to 2025, MS led to nearly 10,000 hospital admissions in Brazil, with hospital mortality rates two to three times higher than those reported in high-income countries. The economic impact of almost R$ 25 million reinforces the significance of MS within the framework of a universal public healthcare system. Regional disparities emphasize the urgent need for public health policies to improve equitable access to specialized care and to reduce preventable hospitalizations.