Presentation (CTI)

OBJECTIVES: In multiple myeloma (MM), an incurable hematologic malignancy with rising global incidence, treatment effectiveness declines with successive lines of therapy (LOT), while healthcare costs may increase due to the growing use of novel high-cost agents. However, evidence on LOT-stratified healthcare cost patterns in real-world settings remains limited. This study systematically reviewed real-world evidence on LOT-stratified healthcare costs in MM patients across multiple countries.
METHODS: A systematic literature review following PRISMA 2020 guidelines was conducted in PubMed, Embase, and the Cochrane Library (inception to April 2026). Eligible studies used real-world data sources and reported healthcare costs (total, drug, or hospitalization) stratified by line of therapy (LOT) among adult patients with multiple myeloma (MM). Cost-effectiveness studies and budget impact analyses were excluded. Two reviewers independently screened and extracted data. Relative cost trends across LOTs were assessed within studies without cross-country cost standardization.
RESULTS: Eleven studies from the US, Europe (France, Germany, UK, Italy, Spain), and Korea were included. Definitions of LOT varied across studies and countries due to differences in clinical practice patterns and data sources. Total healthcare costs increased across LOTs in most countries, primarily driven by rising drug costs associated with the use of novel agents in later-line treatment. Among studies reporting progression status, costs were consistently higher in patients with disease progression than in those without progression. Absolute cost levels at later lines varied substantially: US studies reported costs exceeding $100,000 PPPY, European studies ranged from approximately €23,000 to €90,000, and Korean studies reported comparatively lower costs, likely reflecting differences in drug coverage and reimbursement policies.
CONCLUSIONS: Real-world healthcare costs in multiple myeloma (MM) increase across successive LOTs, with drug expenditures representing the primary cost driver. These findings highlight the substantial economic burden of later-line MM treatment and may help inform reimbursement and health policy discussions across healthcare systems.