Fiscal burden of multiple myeloma in Croatia: a whole-of-government analysis.

AIM: To estimate the direct and indirect fiscal burden of multiple myeloma (MM) in Croatia and assess how it is to evolve through 2030. METHODS: The fiscal burden of MM in Croatia was assessed using a whole-of-government fiscal consequences framework. Administrative data on incidence, mortality, treatment expenditure, sick leave, disability, and macroeconomic indicators were used to model direct health care costs, tax losses linked to morbidity, mortality, absenteeism, caregiver productivity losses, and excess sick leave and disability costs. Healthcare costs were gross reimbursement expenditures of the Croatian Health Insurance Fund before confidential rebates. Projections to 2030 were based on linear extrapolation of the 2009-2024 series. RESULTS: The total fiscal burden of MM in Croatia increased from €9.37 million in 2009 to €44.99 million in 2024. It is projected to reach €60.30 million in 2030. The share of direct health care costs in 2009 accounted for 76% of total costs; in 2024 it accounted for 89%; under a linear status-quo projection, in 2030 it would reach 84%. The total annual fiscal burden per prevalent patient increased from €7319 in 2009 to €19 689 in 2024. CONCLUSION: MM imposes a substantial and growing fiscal burden in Croatia, driven primarily by rising health care costs and, increasingly, by productivity losses. Policies that improve timely access to effective therapies, support caregivers, and maintain patients' workforce attachment could generate modest but measurable fiscal benefits. Reimbursement decisions should therefore move beyond direct medical costs and incorporate broader fiscal consequences to support more efficient, whole-of-government health investment over time.