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's Choice of Treatment in Spain.

Background: Elranatamab is a bispecific anti-B-cell maturation antigen (BCMA) and -CD3 antibody recently approved in Spain for the treatment of adult patients with triple-class exposed relapsed and refractory multiple myeloma (TCE-RRMM). The objective of this analysis was to assess its cost-effectiveness versus teclistamab, another recently approved bispecific antibody, and a treatment basket representing current physician's choice of treatment (PCT).

Methods: A partitioned survival model with three health states was adapted to the Spanish setting. Efficacy data were obtained from the MagnetisMM-3 clinical trial for elranatamab, and from a matching adjusted indirect comparison (MAIC) of elranatamab versus teclistamab and PCT. Utility values were gathered from the MagnetisMM-3 trial for each health state. Only direct costs (2024 €) were considered. Deterministic and probabilistic sensitivity analyses were conducted to assess the uncertainty of the variables and determine the robustness of the results.

Results: Treatment with elranatamab is cost-effective compared to PCT, generating 0.92 additional quality-adjusted life years (QALYs) and an additional €17,860 over a lifetime horizon, yielding an incremental cost-effectiveness ratio (ICER) of €24,754/QALY. Elranatamab is dominant (less costly, more effective) versus teclistamab, providing 0.60 additional QALYs and generating cost savings (- €101,026). Sensitivity analyses confirmed the direction of the base case results.

Conclusions: Elranatamab is a cost-effective treatment versus PCT and dominant over teclistamab for the treatment of adult patients with TCE-RRMM in the Spanish setting.