OBJECTIVES:  Multiple myeloma (MM) is an incurable plasma-cell neoplasm affecting mainly elderlies. The health-economic impact of MM on resource use and costs has not been previously explored outside of the contexts of the USA and Western Europe. Therefore, we assessed treatment patterns, health care utilization and costs of MM management for elderly patients who are not transplant candidates in Serbia. METHODS: We performed a micro-costing study from a Serbian national health system perspective including costs of diagnostic procedures, treatment, hospitalization, outpatient care, drug administration and adverse events management. We followed recommendations of the Serbian guideline for cost-effectiveness analysis. Current MM management protocols were derived from the guideline for diagnosis and treatment of MM in Serbia, revised and adapted by the Serbian clinical experts. For the unit costs of diagnostic procedures, medications and hospital days, we used the Tariff Book of the Serbian republic health Insurance. Data on progression, survival and adverse events were extracted from the clinical trials. Costs were calculated as a product of unit costs and their frequency over a lifelong time horizon and converted to 2016 euros (1€=123.5 Serbian dinars). RESULTS: Average per patient costs of the treatment lines adjusted for survival were as follows: 16,370€ for the first-line, 19,110€ for the second-line (bortezomib- and thalidomide-based regimens used in both first- and second-line protocols), 8,320€ for the third-line treatment (lenalidomide/standard chemotherapy) and 42€ for palliative treatment. Treatment costs varied significantly among thalidomide-based and bortezomib-based regimens (1,800€ vs 28,300€ respectively) and lenalidomide-based regimens and standard chemotherapy (54,900€ vs 300€ respectively). Average lifetime costs for diagnostic procedures and hospitalization were 3,320€ and 800€ respectively. CONCLUSIONS:  The costs of MM treatment in the Serbian context are mainly driven by anti-myeloma drug costs. The development of a country-specific decision-analytic model assessing benefits, harms and costs would help rational use of available treatments.