{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T06:08:36Z","timestamp":1788761316800,"version":"build-2803163510"},"posted":{"date-parts":[[2025,9,25]]},"group-title":"Medicine and Pharmacology","reference-count":0,"publisher":"MDPI AG","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,9,24]]},"abstract":"<jats:p>Background\/Objectives: Multiple myeloma (MM) remains incurable despite decades of pharmacological advances. Triplet and quadruplet regimens improve survival, yet their cumulative toxicity and escalating costs limit long-term value. Cellular immunotherapies such as BCMA-directed CAR-T cells have demonstrated unprecedented efficacy, but they are often reserved for late relapse, when benefit is reduced. This study aimed to evaluate the cost-effectiveness of CAR-T compared with historical and contemporary regimens. Methods: We developed a cost-effectiveness framework using ECOG performance-based utility scores to calculate quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Historical treatments were anchored to Dr. Solly\u2019s 1844 case as baseline, while modern regimens and CAR-T trials were analyzed using stand-ardized survival and drug cost data. A See-Saw model was applied to visualize cumula-tive QALY and ICER values across treatment sequences. Results: Conventional regimens frequently exceeded USD 3\u20134 million per patient with limited QALY gains. In contrast, BCMA-directed CAR-T therapies (ide-cel, cilta-cel), despite 2025 upfront costs of USD 700,000\u20131,000,000, produced superior ICER values and higher cumulative QALYs, par-ticularly in high-risk and refractory cohorts. Earlier integration of CAR-T projected both economic and clinical superiority, while delayed use reduced its effectiveness. Conclu-sions: Our analysis reframes CAR-T as not a financial burden but a cost-effective, ethically imperative therapy. Earlier adoption could reduce cumulative expenditure, enhance qual-ity-adjusted survival, and mitigate inequities in MM care. Aligning innovation with access is essential to ensure that the right to live longer and better does not depend on wealth.<\/jats:p>","DOI":"10.20944\/preprints202509.2132.v1","type":"posted-content","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:28:59Z","timestamp":1758846539000},"source":"Crossref","is-referenced-by-count":0,"title":["CAR-T Therapy in Multiple Myeloma: Beyond Prejudice, Towards Value"],"prefix":"10.20944","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5367-6687","authenticated-orcid":false,"given":"Guluzar Gulnur","family":"Itez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asuman","family":"Sunguro\u011flu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","container-title":[],"original-title":[],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:40:26Z","timestamp":1788759626000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.preprints.org\/manuscript\/202509.2132\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,25]]},"references-count":0,"URL":"https:\/\/doi.org\/10.20944\/preprints202509.2132.v1","relation":{"is-version-of":[{"id-type":"doi","id":"10.20944\/preprints202509.2132.v2","asserted-by":"subject"}],"is-preprint-of":[{"id-type":"doi","id":"10.1177\/20406207261484713","asserted-by":"subject"}],"has-version":[{"id-type":"doi","id":"10.20944\/preprints202509.2132.v2","asserted-by":"object"}]},"subject":[],"published":{"date-parts":[[2025,9,25]]},"subtype":"preprint"}}