OBJECTIVES: Evaluation of healthcare resource utilisation (HRU) associated with management of patients with symptomatic multiple myeloma (MM) in Italy. METHODS: Oncologists and haematologists completed case report forms for patients who, in the 3 months before study initiation, either progressed after receiving specific treatment regimens (those most commonly prescribed) or received best supportive care (BSC) and died. Patient characteristics, treatment outcomes, costs and HRU were collected retrospectively from the beginning of the last completed treatment line onwards, for patients receiving: second- or third-line lenalidomide or bortezomib; fourth-line lenalidomide, bortezomib or bendamustine; any regimen as fifth line or greater; BSC only. Specific costs were obtained from the Italian Drug Agency, the Ministry of Health and Codifa. Costs of other drugs and resources (e.g. hospitalisation and laboratory tests) were estimated based on standardised schedules. RESULTS: Physicians (n=57) provided data on patients receiving active treatment (n=355) or BSC (n=38). The mean (standard deviation [SD]) duration of a therapy line (second to fourth line) was 15.6 (15.9) months (active treatment: 9.0 (7.9) months; treatment-free interval before progression:  6.6 (13.5) months). The mean total cost (SD) per treatment line was €38,402 (42,569); most costs were attributable to anti-tumour drugs (94.2%). The cost of managing adverse events (AEs) ranged from €79 to €4,415 per event.  Excluding anti-tumour drugs and managing AEs, costs were incurred by laboratory tests (30% of total cost), hospitalisation (27%), concomitant medication (26%), procedures (10%) and outpatient consultations (7%). The mean total cost (SD) for BSC was €3,169 (3969) for patients who progressed following discontinuation of active treatment and €2,485 (3844) for those who did not progress before death. CONCLUSIONS:  In Italy, management of patients with relapsed MM is expensive. Most costs result from anti-tumour drugs and AE management, and the remainder are attributable to laboratory tests, hospitalisation and concomitant medication.