CAR-T Therapy in Multiple Myeloma: Beyond Prejudice, Towards Value

Background: /Objectives: Multiple myeloma (MM) remains incurable despite decades of pharmacological advances. Triplet and quadruplet regimens improve survival, yet their cumulative toxicity and escalating costs limit long-term value. Cellular immunotherapies such as BCMA-directed CAR-T cells have demonstrated unprecedented efficacy, but they are often reserved for late relapse, when benefit is reduced. This study aimed to evaluate the cost-effectiveness of CAR-T compared with historical and contemporary regimens. Methods: We developed a cost-effectiveness framework using ECOG performance-based utility scores to calculate quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Historical treatments were anchored to Dr. Solly’s 1844 case as baseline, while modern regimens and CAR-T trials were analyzed using stand-ardized survival and drug cost data. A See-Saw model was applied to visualize cumula-tive QALY and ICER values across treatment sequences. Results: Conventional regimens frequently exceeded USD 3–4 million per patient with limited QALY gains. In contrast, BCMA-directed CAR-T therapies (ide-cel, cilta-cel), despite 2025 upfront costs of USD 700,000–1,000,000, produced superior ICER values and higher cumulative QALYs, par-ticularly in high-risk and refractory cohorts. Earlier integration of CAR-T projected both economic and clinical superiority, while delayed use reduced its effectiveness. Conclu-sions: Our analysis reframes CAR-T as not a financial burden but a cost-effective, ethically imperative therapy. Earlier adoption could reduce cumulative expenditure, enhance qual-ity-adjusted survival, and mitigate inequities in MM care. Aligning innovation with access is essential to ensure that the right to live longer and better does not depend on wealth.