OBJECTIVES: To estimate the cost-effectiveness of bortezomib, thalidomide, and dexamethasone (VTD) induction therapy, versus TD alone in newly diagnosed multiple myeloma (ndMM) patients eligible for autologous stem cell transplantation (ASCT) in Germany. METHODS: A life-time Markov model with monthly cycles is used to model disease progression and generate cost per quality-adjusted life years (QALY). It includes five health states; four of which are related to the lines of treatment, and death. Patients enter the first line state at randomisation and receive induction usually followed by ASCT. Patients can move to the next line upon progression or die within a line, until they enter the final (4+) line where they remain until death. Transition probabilities are derived from multi-state survival analysis of patient level data from the PETHEMA-trial for first line, the APEX-trial for second and third line, and an observational data set (eVOBS) for further lines. The model uses ASCT and time dependent utilities from the literature and trial estimated grade ≥3 adverse events (AEs) associated disutilities to calculate the QALYs. Cost estimates related to treatments, transplant and AEs are based on German specific sources. A payer’s perspective is chosen. Discount rates of 3% for both cost and utilities are applied. RESULTS: Total life years of 6.38 VTD and 5.06 for TD with first line duration of 50.47 versus 32.85 months respectively. Incremental costs of VTD versus TD are 22,179€ [95%CI:6,950€;33,528€] and incremental QALYs are 0.72 [95%CI:0.33;1.20], resulting in an ICER of €30,655 per QALY gained. The univariate analyses show that the model is most sensitive to induction cost and percentage transplants. At a willingness-to-pay threshold of 35,000€ per QALY gained, VTD has a 57.1% probability to be cost-effective in this setting. CONCLUSIONS: VTD induction is a cost-effective strategy for ndMM patients eligible for ASCT in Germany compared to TD.