Multiple myeloma is a neoplastic proliferation of a plasma cell clone that produces a monoclonal immunoglobulin. It is one of the most common haematological malignancies and the incidence increases with age, with a median age at diagnosis of 65–70 years. The diagnosis of multiple myeloma requires the presence of ≥10% plasma cells in the bone marrow and an M-protein in serum and/or urine. Cytogenetic status, serum β2-microglobulin and response to therapy are the key prognostic factors. Treatment is necessary for the patient diagnosed with symptomatic multiple myeloma, with organ damage. Patients older than 65 years are ineligible for autologous transplantation. The introduction of novel agents, such as thalidomide, bortezomib and lenalidomide, have changed the management of myeloma and extended overall survival. However, in older patients the results are not as satisfactory and treatment strategies have to be individualized to improve tolerability and optimize efficacy.

Objectives: To compare cost effectiveness models for the first-line treatment of multiple myeloma, and explore the differences between the models’ structure, parameters, assumptions and results.

Methods: Three cost effectiveness models for the treatment of multiple myeloma, were compared that had been developed to inform resource allocation in the UK for the chemotherapy regimens bortezomib, melphalan and prednisolone (BMP); and melphalan, prednisolone and thalidomide (MPT) versus melphalan and prednisolone (MP). The models used alternative approaches and assumptions to estimate the overall survival and progression-free survival for each of the interventions. Through the use of sensitivity analyses, the most influential parameters and assumptions of each of the models were identified.

Results: The models developed by the manufacturers gave conflicting results, with each manufacturer favouring their drug. The differences between the model results were determined by two parameters: the hazard ratio for overall survival for MPT vs. MP and the cost of bortezomib.

Conclusions: Using models developed for assessing treatments for multiple myeloma we demonstrated that it was feasible to compare models, which then aided decision makers in making reimbursement decisions.