Cost-Effectiveness of Elranatamab Versus Teclistamab for the Management of Patients with Triple-Class Exposed Relapsed/Refractory Multiple Myeloma in Italy

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—progression-free survival, post-progression survival, and death—was 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.