In many medical studies, there are covariates that change their values over time and their analysis is most often modeled using the Cox regression model. However, many of these time-dependent covariates can be expressed as an intermediate event, which can be modeled using a multi-state model. Using the relationship of time-dependent (discrete) covariates and multi-state models, we compare (via simulation studies) the Cox model with time-dependent covariates with the most frequently used multi-state regression models. This article also details the procedures for generating survival data arising from all approaches, including the Cox model with time-dependent covariates.