OBJECTIVES: To estimate direct medical costs associated with multiple myeloma (MM) in publically insured Chinese patients. METHODS: China Health Insurance Research Association (CHIRA) claim data containing patients randomly selected from publically insured urban residents and workers across China was used to identify patients with MM and their insurance claim records in 2013. The pattern of prescribed medications in the identified patients was used to determine the treatment settings for the estimations of direct medical costs. Generalized linear model (GLM) was used to assess the impact of treatment settings on the direct medical costs after full adjustment of patient baseline demography, complications, and comorbidities. RESULTS: The identified 522 patients with MM were stratified by treatment settings as induction treatment (n=172), stem cell transplantation (SCT) (n=7), first-line treatment (n=186), second-line treatment (n=71), and palliative care (n=86).  The total medical costs associated with treatment settings were RMB 69,126 for induction treatment, RMB 102,250 for SCT, RMB 77,871 for first-line treatment, RMB 31,193 for second-line treatment, and RMB 23,127 for palliative care, respectively (1 RMB = 0.16 US$). Based on the multivariate GLM regression analysis, living in central cities (coefficient 0.319, p=0.042), treatment settings prior to palliative care (induction treatment: coefficient 1.150, p<0.001; SCT: coefficient 1.804, p<0.001; first-line treatment: coefficient 1.062, p<0.001; second-line treatment: coefficient 0.377, p=0.019), pulmonary infection (coefficient 0.780, p<0.001), and  suppressed bone marrow function (coefficient 0.352, p=0.047) were significantly associated with increased direct medical costs and urban resident insurance (coefficient -0.410, p<0.001) was significantly associated with less direct medical costs.     CONCLUSIONS: The direct medical costs associated with MM in publically insured Chinese patients varied substantially by treatment settings. Except treatment settings, complications, and comorbidities, the social economic status associated with insurance type and residence city size have a substantial impact on public health resource utilization in Chinese patients with MM.