OBJECTIVES : Multiple Myeloma (MM) is a severe disease characterized by extensive inter-patient heterogeneity, which is also reflected in the patient pathways. Moreover, patient pathways are highly heterogeneous across different jurisdictions. Current health economic models only focus on the economic analysis of a single decision and only vaguely consider the wider context. This research aimed to establish transparency of economic evaluations in health technologies in MM and provide guidance and recommendations for future health economic analyses.

METHODS : A systemic literature review was conducted using original economic assessment studies and structured review papers of economic assessment studies in MM using the following databases: Medline, Scopus, Cochrane Database of Systematic Reviews, PROSPERO, CRD database CEA Registry, and websites of HTA Agencies. The search was limited to English language papers published from January 1, 2000 onwards.

RESULTS : Most of the published health economic analyses supported by models came from high-income countries. Evaluations from middle-income countries were rarely published. Diagnostic technologies were rarely modelled and integrated care has not been modelled. Very few models are available that investigate MM treatments from a societal perspective and there is a lack of evaluations regarding minimal residual disease (MRD) or individual level decision making aspects.

CONCLUSIONS : Several limitations were identified since results were more likely to come from high-income countries and many elements of the complex and heterogeneous patient pathways in MM were not included in these evaluations. In general, most of the published modelling studies focusing on single decision problems. An open-source Whole Disease Modelling framework is needed (Whole Disease Modelling) that is capable of assessing the cost-effectiveness of a wide range of interventions in various jurisdictions.