Comparative economic analysis of B-cell maturation antigen-targeted bispecific antibodies in triple-class exposed relapsed/refractory multiple myeloma: linvoseltamab versus teclistamab and elranatamab

OBJECTIVE: To evaluate the total cost of care, average monthly treatment cost, and cost per outcome of linvoseltamab versus teclistamab and elranatamab in triple-class-exposed relapsed/refractory multiple myeloma (RRMM) using matching-adjusted indirect comparisons (MAICs). METHODS: Total cost per patient and cost per outcome were estimated over 1- and 2-year time horizons from a United States commercial payer perspective. Cost components included drug acquisition, administration, monitoring, adverse events, progression, and death. Dosing schedules were applied per prescribing information, aligning with pivotal trial-based MAIC-adjusted clinical inputs. Costs were sourced from databases and published literature. RESULTS: The 1- and 2-year cumulative costs were $387,773 and $488,088 with linvoseltamab versus $500,670 and $639,013 with teclistamab; costs per progression-free (PF) month were $40,904 and $29,036 versus $63,057 and $50,877; costs per overall response were $538,573 and $677,901 versus $794,714 and $1,014,307. The 1- and 2-year cumulative costs were $383,368 and $472,907 with linvoseltamab versus $416,359 and $475,918 with elranatamab, for adjusted median treatment durations of 11.3 versus 5.6 months; 1- and 2-year costs per PF month were $43,417 and $29,912 versus $50,529 and $33,304, while costs per overall response were $539,955 and $666,066 versus $682,556 and $780,193. CONCLUSION: Linvoseltamab had lower total costs and cost per outcome than teclistamab at 1- and 2-year timepoints. Linvoseltamab had comparable total costs to elranatamab despite longer treatment duration, and consistently lower costs per outcome. Within this exploratory MAIC model, linvoseltamab was associated with lower economic burden in heavily pretreated RRMM. These results should be interpreted considering study assumptions and limitations.