{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T06:41:10Z","timestamp":1774593670224,"version":"3.50.1"},"reference-count":38,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"crossref","award":["14.000"],"award-info":[{"award-number":["14.000"]}],"id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Multiple myeloma remains an incurable malignancy in which patients ultimately experience relapses and refractory disease despite therapeutic advances. Triple-class exposed relapsed\/refractory MM (TCE\/RRMM) patients represent both a population with high unmet clinical needs and a substantial economic burden for the Italian National Health Service (NHS). Recently, BCMA-CD3 bispecific antibodies, including elranatamab and teclistamab, have expanded the treatment options for these patients. This study aimed to evaluate the cost-effectiveness of elranatamab versus teclistamab in adults with TCE\/RRMM from the Italian NHS perspective. Methods: A partitioned survival model with three health states\u2014progression-free survival, post-progression survival, and death\u2014was developed over a 25-year lifetime horizon, adopting weekly cycles and a 3% annual discount rate. Clinical data for elranatamab were derived from the MagnetisMM-3 trial, while teclistamab outcomes were estimated through matching-adjusted indirect comparisons using MajesTEC-1 data. Direct medical costs included those associated with drug acquisition and administration, disease management, adverse event management, and end-of-life care. Utility values were obtained from EQ-5D-based assessments in MagnetisMM-3. Deterministic and probabilistic sensitivity analyses were performed to test model robustness. Results: Elranatamab yielded 3.31 life-years and 2.33 QALYs per patient, compared with 1.83 life-years and 1.27 QALYs for teclistamab. Total lifetime costs were lower for elranatamab (EUR 153,337) versus teclistamab (EUR 224,610), generating EUR 71,273 in savings. Thus, elranatamab is considered to be dominant, due to its higher efficacy and lower cost. Furthermore, the robustness of these findings was confirmed through sensitivity analyses. Conclusions: From the Italian NHS perspective, elranatamab represents a clinically superior and economically favorable option for patients with TCE\/RRMM. The obtained results support its value and sustainability within the national treatment landscape.<\/jats:p>","DOI":"10.3390\/cancers18071070","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T13:36:40Z","timestamp":1774532200000},"page":"1070","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-Effectiveness of Elranatamab Versus Teclistamab for the Management of Patients with Triple-Class Exposed Relapsed\/Refractory Multiple Myeloma in Italy"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1522-4504","authenticated-orcid":false,"given":"Cirino","family":"Botta","sequence":"first","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgio Lorenzo","family":"Colombo","sequence":"additional","affiliation":[{"name":"Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy"},{"name":"CEFAT\u2014Center of Pharmaceuticals Economics and Medical Technologies Evaluation, Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergio","family":"Di Matteo","sequence":"additional","affiliation":[{"name":"Center of Research, SAVE Studi\u2014Health Economics and Outcomes Research, 20100 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Martinotti","sequence":"additional","affiliation":[{"name":"Center of Research, SAVE Studi\u2014Health Economics and Outcomes Research, 20100 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma Lucia","family":"Fogliati","sequence":"additional","affiliation":[{"name":"Center of Research, SAVE Studi\u2014Health Economics and Outcomes Research, 20100 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4571-654X","authenticated-orcid":false,"given":"Giacomo Matteo","family":"Bruno","sequence":"additional","affiliation":[{"name":"Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Novelli","sequence":"additional","affiliation":[{"name":"Pfizer s.r.l., 00100 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Di Virgilio","sequence":"additional","affiliation":[{"name":"Pfizer s.r.l., 00100 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Veggia","sequence":"additional","affiliation":[{"name":"Pfizer s.r.l., 00100 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7899-5966","authenticated-orcid":false,"given":"Sara","family":"Galimberti","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, 56100 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1053\/j.seminoncol.2016.11.004","article-title":"Multiple myeloma epidemiology and survival: A unique malignancy","volume":"43","author":"Kazandjian","year":"2016","journal-title":"Semin. Oncol."},{"key":"ref_2","unstructured":"Albagoush, S.A., Shumway, C., and Azevedo, A.M. (2022). Multiple Myeloma. StatPearls, StatPearls Publishing. Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK534764\/."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Padala, S.A., Barsouk, A., Barsouk, A., Rawla, P., Vakiti, A., Kolhe, R., Kota, V., and Ajebo, G.H. (2021). Epidemiology, Staging, and Management of Multiple Myeloma. Med. Sci., 9.","DOI":"10.3390\/medsci9010003"},{"key":"ref_4","first-page":"75","article-title":"A Real-World Analysis of Patients with Triple Class Exposed Multiple Myeloma in Italy: Epidemiology Estimates, Treatment Pattern and Economic Burden","volume":"26","author":"Perrone","year":"2025","journal-title":"Farmecon. Health Econ. Ther. Pathw."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1200\/EDBK_349603","article-title":"Moving Toward a Cure for Myeloma","volume":"42","author":"Mateos","year":"2022","journal-title":"Am. Soc. Clin. Oncol. Educ. Book"},{"key":"ref_6","unstructured":"(2025, September 10). Estimates of Cancer Incidence and Mortality in 2022, for All Countries. Available online: https:\/\/ecis.jrc.ec.europa.eu\/explorer.php."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2343","DOI":"10.1038\/s41375-019-0561-2","article-title":"Relapsed refractory multiple myeloma: A comprehensive overview","volume":"33","author":"Bazarbachi","year":"2019","journal-title":"Leukemia"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.clml.2024.12.002","article-title":"Real-World Treatment Patterns and Clinical Outcomes in Patients with Multiple Myeloma Previously Treated with Lenalidomide and an Anti-CD38 Monoclonal Antibody","volume":"25","author":"Ramasamy","year":"2025","journal-title":"Clin. Lymphoma Myeloma Leuk."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Podar, K., and Leleu, X. (2021). Relapsed\/Refractory Multiple Myeloma in 2020\/2021 and Beyond. Cancers, 13.","DOI":"10.3390\/cancers13205154"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1080\/10428194.2024.2313628","article-title":"A matching adjusted indirect comparison of the efficacy of elranatamab versus teclistamab in patients withtriple-class exposed\/refractory multiple myeloma","volume":"65","author":"Mol","year":"2024","journal-title":"Leuk. Lymphoma"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2259","DOI":"10.1038\/s41591-023-02528-9","article-title":"Elranatamab in relapsed or refractory multiple myeloma: Phase 2 MagnetisMM-3 trial results","volume":"29","author":"Lesokhin","year":"2023","journal-title":"Nat. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1056\/NEJMoa2203478","article-title":"Teclistamab in Relapsed or Refractory Multiple Myeloma","volume":"387","author":"Moreau","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_13","unstructured":"Associazione Italiana di Economia Sanitaria (2009). Proposta di linee guida per la valutazione economica degli interventi sanitari. Politiche Sanit., 10, 91\u201399."},{"key":"ref_14","unstructured":"AIFA (2025, September 10). Linee Guida per la Compilazione del Dossier a Supporto Della Domanda di Rimborsabilit\u00e0 e di Prezzo, Available online: https:\/\/www.aifa.gov.it\/documents\/20142\/1283800\/Linee_guida_dossier_domanda_rimborsabilita.pdf."},{"key":"ref_15","unstructured":"Geodemo Istat (2025, September 10). Tavole di Mortalit\u00e0 per Popolazione Residente. Available online: https:\/\/demo.istat.it\/tvm2016\/index.php?lingua=ita."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s40273-022-01215-w","article-title":"Role of Economic Evaluations on Pricing of Medicines Reimbursed by the Italian National Health Service","volume":"41","author":"Russo","year":"2023","journal-title":"Pharmacoeconomics"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.jval.2013.02.002","article-title":"Consolidated Health Economic Evaluation Reporting Standards (CHEERS): Explanation and elaboration: A report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force","volume":"16","author":"Husereau","year":"2013","journal-title":"Value Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e136","DOI":"10.1002\/hem3.136","article-title":"Long-term survival and safety of elranatamab in patients with relapsed or refractory multiple myeloma: Update from the MagnetisMM-3 study","volume":"8","author":"Tomasson","year":"2024","journal-title":"Hemasphere"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"7540","DOI":"10.1200\/JCO.2024.42.16_suppl.7540","article-title":"Long-term follow-up from the phase 1\/2 MajesTEC-1 trial of teclistamab in patients with relapsed\/refractory multiple myeloma","volume":"42","author":"Garfall","year":"2024","journal-title":"Am. Soc. Clin. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"8034","DOI":"10.1200\/JCO.2023.41.16_suppl.8034","article-title":"Durability of responses with biweekly dosing of teclistamab in patients with relapsed\/refractory multiple myeloma achieving a clinical response in the MajesTEC-1 study","volume":"41","author":"Usmani","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Guyot, P., Ades, A.E., Ouwens, M.J., and Welton, N.J. (2012). Enhanced secondary analysis of survival data: Reconstructing the data from published Kaplan-Meier survival curves. BMC Med. Res. Methodol., 12.","DOI":"10.1186\/1471-2288-12-9"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s40273-022-01218-7","article-title":"Estimating the Relationship Between EQ-5D-5L and EQ-5D-3L: Results from a UK Population Study","volume":"41","author":"Pudney","year":"2023","journal-title":"PharmacoEconomics"},{"key":"ref_23","unstructured":"Agenzia Italiana del Farmaco (2025, October 05). Elranatamab\u2014Determina 21 maggio 2024. Classificazione ai sensi dell\u2019art. 12, Comma 5, della Legge 8 Novembre 2012, n. 189, del Medicinale per uso Umano a Base di Elranatamab \u201cElrexfio\u201d (Determina n. 75\/2024), Gazzetta Ufficiale della Repubblica Italiana, Available online: https:\/\/www.gazzettaufficiale.it\/eli\/id\/2024\/06\/06\/24A02748\/SG."},{"key":"ref_24","unstructured":"Agenzia Italiana del Farmaco (2025, October 05). Teclistamab\u2014Determina 2 ottobre 2023. Riclassificazione del medicinale per uso umano \u201cTecvayli\u201d, ai sensi dell\u2019art. 8, comma 10, della legge 24 dicembre 1993, n. 537 (Determina n. 606\/2023), Gazzetta Ufficiale della Repubblica Italiana, Available online: https:\/\/www.gazzettaufficiale.it\/atto\/serie_generale\/caricaDettaglioAtto\/originario?atto.dataPubblicazioneGazzetta=2023-10-11&atto.codiceRedazionale=23A05550&elenco30giorni=false."},{"key":"ref_25","unstructured":"European Medicines Agency (2025, October 05). Elrexfio: EPAR\u2014Product Information. Available online: https:\/\/www.ema.europa.eu\/it\/documents\/product-information\/elrexfio-epar-product-information_it.pdf."},{"key":"ref_26","unstructured":"European Medicines Agency (2025, October 05). Tecvayli: EPAR\u2014Product Information. Available online: https:\/\/www.ema.europa.eu\/it\/documents\/product-information\/tecvayli-epar-product-information_it.pdf."},{"key":"ref_27","unstructured":"Farmadati Italia (2025, October 05). GALLERY\u00ae\u2014Compendio Farmadati WEB. Available online: https:\/\/gallery.farmadati.it\/."},{"key":"ref_28","unstructured":"Ministro della Salute, Italia (2025, November 25). Decreto del Ministro della Salute 25 Novembre 2024. Nomenclatori e Tariffe Nazionali delle Prestazioni del Servizio Sanitario Nazionale\u2014Allegato 4: Nomenclatore delle Prestazioni di Assistenza Specialistica Ambulatoriale, Gazzetta Ufficiale della Repubblica Italiana, Available online: https:\/\/www.trovanorme.salute.gov.it\/norme\/dettaglioAtto?id=58669&articolo=68."},{"key":"ref_29","unstructured":"Ministry of Health (2025, October 25). Principali caratteristiche dei Diagnosis Related Groups (DRG)\u2014Allegato 1: Tariffe per la remunerazione delle prestazioni di assistenza ospedaliera per acuti, Gazzetta Ufficiale della Repubblica Italiana, Available online: https:\/\/www.trovanorme.salute.gov.it\/norme\/renderPdf.spring?seriegu=SG&datagu=28\/01\/2013&redaz=13A00528&artp=1&art=1&subart=1&subart1=10&vers=1&prog=001."},{"key":"ref_30","unstructured":"De Palma, R., Fortuna, D., Hegarty, S., Louis, D.Z., Melotti, R.M., and Moro, M.L. (2025, September 10). Dossier n. 270\/2021\u2014L\u2019assistenza nel Fine Vita ai Pazienti Oncologici in Emilia-Romagna nel Decennio 2010\u20132019, Available online: https:\/\/assr.regione.emilia-romagna.it\/pubblicazioni\/dossier\/doss270."},{"key":"ref_31","unstructured":"National Institute for Health and Care Excellence (NICE) (2022). NICE Health Technology Evaluations: The Manual, NICE. Available online: https:\/\/www.nice.org.uk\/process\/pmg36."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2269","DOI":"10.1182\/blood-2025-2269","article-title":"Prolonged elranatamab treatment interruption in patients with relapsed or refractory multiple myeloma (RRMM) is feasible: A retrospective analysis from MagnetisMM-3","volume":"146","author":"Lesokhin","year":"2025","journal-title":"Blood"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1007\/s40487-025-00333-7","article-title":"Cost-Effectiveness of Elranatamab Versus Current Therapies for the Management of Patients with Triple-Class Exposed, Relapsed and Refractory Multiple Myeloma, Including Other Bispecific and Physician\u2019s Choice of Treatment in Spain","volume":"13","author":"Encinas","year":"2025","journal-title":"Oncol Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1080\/13696998.2025.2514909","article-title":"Cost per responder for teclistamab and elranatamab in relapsed or refractory multiple myeloma in the United States","volume":"28","author":"Gordan","year":"2025","journal-title":"J. Med. Econ."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1038\/s41408-024-01200-w","article-title":"Elranatamab monotherapy in the real-word setting in relapsed-refractory multiple myeloma: Results of the French compassionate use program on behalf of the IFM","volume":"14","author":"Malard","year":"2024","journal-title":"Blood Cancer J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S77","DOI":"10.1016\/j.jval.2025.04.377","article-title":"Real-World Healthcare Resource Utilization and Costs Associated with Elranatamab Initiation in Multiple Myeloma: The ALTITUDE-1 Study","volume":"28","author":"Banerjee","year":"2025","journal-title":"Value Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.1016\/j.jval.2024.03.315","article-title":"Cost-of-Care Comparison of Elranatamab-bcmm and Teclistamab-cqyv in Adult Patients with Relapsed or Refractory Multiple Myeloma (RRMM)","volume":"27","author":"Shah","year":"2024","journal-title":"Value Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"289","DOI":"10.2147\/CEOR.S501404","article-title":"Economic Impact of Elranatamab for Treatment of Patients with Relapsed or Refractory Multiple Myeloma","volume":"17","author":"Shah","year":"2025","journal-title":"Clin. Outcomes Res."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/7\/1070\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T05:14:14Z","timestamp":1774588454000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/7\/1070"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,25]]},"references-count":38,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["cancers18071070"],"URL":"https:\/\/doi.org\/10.3390\/cancers18071070","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,25]]}}}