{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:19:06Z","timestamp":1787548746951,"version":"build-2736575974"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Multiple myeloma (MM) is a hematologic malignancy that predominantly affects older adults and poses substantial therapeutic challenges due to the high prevalence of comorbidities and limited treatment tolerability. This study evaluates the cost-effectiveness of four first-line treatment regimens for elderly MM patients, ineligible for autologous stem cell transplantation (ASCT): bortezomib, melphalan, and prednisone (VMP); daratumumab in combination with VMP (D-VMP); lenalidomide and dexamethasone (Rd); and daratumumab combined with Rd (DARA-Rd).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A state-transition Markov model was developed, with transition probabilities parameterized using data derived from the pivotal ALCYONE and MAIA clinical trials. Cost-effectiveness was assessed from the perspective of the Italian National Health Service using a state-transition model comparing VMP, D-VMP, Rd and DARA-Rd over a 5.25-year horizon. Probabilistic sensitivity analyses (PSA) were conducted to account for parameter uncertainty and summarized through cost-effectiveness acceptability curves (CEACs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Rd generated 1.53 QALYs for \u20ac60,483, whereas D-VMP generated 1.70 QALYs at \u20ac88,331, resulting in an ICER of \u20ac160,804\/QALY. DARA-Rd and VMP were dominated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings indicate that Rd is the strategy with the highest probability of being cost-effective at willingness-to-pay (WTP) thresholds below \u20ac250,000 per quality-adjusted life year (QALY) gained. Conversely, for WTP thresholds exceeding \u20ac250,000 per QALY gained, D-VMP emerges as the preferred option, offering the most favorable balance between additional costs and health benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1774263","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T04:24:18Z","timestamp":1787545458000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrating clinical and economic outcomes in the elderly myeloma management: a comparative cost-effectiveness analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Antonio G.","family":"Solimando","sequence":"first","affiliation":[{"name":"Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Unit of Internal Medicine \u2018Guido Baccelli\u2019, University of Bari Aldo Moro Medical School","place":["Bari, 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