Antonio G. Solimando, Vanessa Desantis, Lucia Di Marzo, Giulia De Martino, Simona D’Amore, Leonardo Girardi, Giuseppe Dicuonzo, Alessandro Andriano, Franco Dammacco, Angelo Vacca, Massimo Bilancia, Roberto Ria
Introduction Multiple myeloma (MM) is a hematologic malignancy that predominantly affects older adults and poses substantial therapeutic challenges due to the high prevalence of comorbidities and limited treatment tolerability. This study evaluates the cost-effectiveness of four first-line treatment regimens for elderly MM patients, ineligible for autologous stem cell transplantation (ASCT): bortezomib, melphalan, and prednisone (VMP); daratumumab in combination with VMP (D-VMP); lenalidomide and dexamethasone (Rd); and daratumumab combined with Rd (DARA-Rd). Methods A state-transition Markov model was developed, with transition probabilities parameterized using data derived from the pivotal ALCYONE and MAIA clinical trials. Cost-effectiveness was assessed from the perspective of the Italian National Health Service using a state-transition model comparing VMP, D-VMP, Rd and DARA-Rd over a 5.25-year horizon. Probabilistic sensitivity analyses (PSA) were conducted to account for parameter uncertainty and summarized through cost-effectiveness acceptability curves (CEACs). Results Rd generated 1.53 QALYs for €60,483, whereas D-VMP generated 1.70 QALYs at €88,331, resulting in an ICER of €160,804/QALY. DARA-Rd and VMP were dominated. Conclusion The findings indicate that Rd is the strategy with the highest probability of being cost-effective at willingness-to-pay (WTP) thresholds below €250,000 per quality-adjusted life year (QALY) gained. Conversely, for WTP thresholds exceeding €250,000 per QALY gained, D-VMP emerges as the preferred option, offering the most favorable balance between additional costs and health benefits.