OBJECTIVES: To estimate the incremental cost-effectiveness of bortezomib (BTZ) compared with lenalidomide plus dexamethasone (LEN+DEX) and dexamethasone (DEX) for the treatment of relapsed/refractory multiple myeloma in the Nordic countries. METHODS: The model was based on a ‘partitioned survival analysis’ that allows survival data to be decomposed into three states 1) alive before disease progression; 2) alive after progression; and 3) dead. The effects of treatment on time to progression and overall survival (OS) were obtained from published reports of the APEX, MM-009 and MM-010 randomized clinical trials. OS hazard ratios were estimated using a mixed-treatment-comparison meta analysis. Costs were estimated using published local sources and local Delphi panels, and include drug and administration, adverse events and relapses, and end-of-life costs. Utility estimates are derived from the literature. The robustness was evaluated by 1-way and probabilistic sensitivity analysis. RESULTS: BTZ mean OS is 38.6 months compared to 24.5 and 37.8 months for DEX and LEN+DEX respectively. Mean lifetime direct medical costs for BTZ are ranging from €98,408 (Sweden) to €194,656 (Denmark). For Finland, Norway and Sweden mean incremental cost per LYG of BTZ compared to DEX is between €42,145 and €46,749. The corresponding cost per QALY is between €54,451 and €60,564. Denmark has higher values of €62,748 and €81,560 respectively. BTZ is dominant compared to LEN+DEX in all countries. For the BTZ DEX comparison, the model is most sensitive to changes in utilities prior to relapse, BTZ costs and number of administrations. CONCLUSIONS: BTZ and LEN+DEX are projected to prolong survival relative to DEX. Finland, Norway and Sweden show very similar cost-effectiveness results. Denmark has higher ICERs because of higher cost of care in 2nd and 3rd line implying a relative disadvantage for drugs prolonging life. From a Nordic perspective, BTZ is cost-effective compared to DEX and dominant compared to LEN+DEX.