Background Some evidence suggests that early highly efficacious therapy in relapsing multiple sclerosis might be superior to escalation strategies. Objective A cost-consequence analysis simulated different treatment scenarios with ofatumumab (OMB), dimethyl fumarate (DMF) and glatiramer acetate (GA): immediate OMB initiation as first treatment, early switch to OMB after 1 year on DMF/GA, late switch after 5 years or no switch. Methods The simulation was based on an EDSS-based Markov model with a 10-year time horizon. Cycle transitions included EDSS progression, improvement or stabilization, treatment discontinuation, relapse, or death. Input data were extracted from OMB trials, a network meta-analysis, published literature, and publicly available sources. Results The late switch compared to the immediate OMB scenario resulted in a lower proportion of patients with EDSS 0-3 (Δ-7.5 % DMF; Δ-10.3 % GA), more relapses (Δ + 0.72 DMF; Δ + 1.23 GA) and lower employment rates (Δ-4.0 % DMF; Δ-5.6 % GA). The same applies to late versus early switches. No switch scenarios resulted in worse outcomes. Higher drug acquisition costs in the immediate OMB and early switch scenarios were almost compensated by lower costs for patient care (e. g., inpatient and informal care, community and social services) and productivity loss. Conclusion Immediate OMB treatment and an early switch improves clinical and productivity outcomes while remaining almost cost neutral compared to late or no switches.