Autologous stem-cell transplantation and maintenance therapy for transplant-eligible multiple myeloma patients: cost-effectiveness analysis based on a network meta-analysis

This study aimed to evaluate the cost-effectiveness of ASCT and maintenance therapy strategies for transplant-eligible patients with newly diagnosed multiple myeloma from a Chinese healthcare perspective. A short-run decision tree and a long-run Markov model were created to assess the mean costs and quality-adjusted life-years (QALYs) of ASCT plus maintenance therapy over a lifetime horizon. Utility values were sourced from published literature, while healthcare costs were based on a single-center retrospective analysis and national drug bidding data. The ASCT strategy with two-year daratumumab maintenance had the lowest discounted costs (1,394,183 CNY). Compared to no ASCT with continuous lenalidomide maintenance, ASCT had an ICER of 90,997 CNY/QALY. With one-year lenalidomide maintenance, ASCT provided more QALYs at lower costs. One-year lenalidomide maintenance after ASCT also resulted in higher QALYs and lower costs than no maintenance, while continuous lenalidomide had an ICER of 396,731 CNY/QALY. Under the WTP threshold of CNY 268,074 per QALY, ASCT strategies were more cost-effective than non-ASCT approaches. One-year lenalidomide therapy after ASCT was more cost-effective than no maintenance or continuous therapy. Among all strategies, ASCT followed by two years of daratumumab maintenance was the most cost-effective option.