--- title: "Tovecimig (CTX-009) in Second-line advanced biliary tract cancer: cost-effectiveness analyses and utility weights" description: "Published cost-effectiveness analyses and health-state utility weights for Tovecimig (CTX-009, ABL001) in Second-line advanced biliary tract cancer, each value quoted from the article: 15 cost-effectiveness analyses and 10 studies reporting utility weights. Analyses: Pemigatinib versus mFOLFOX with active symptom control and versus active symptom control alone in relapsed or refractory FGFR2 fusion-positive cholangiocarcinoma, England: NICE TA722 committee discussion (2021); Biomarker-driven pemigatinib or mFOLFOX versus fluorouracil chemotherapy in previously treated advanced intrahepatic cholangiocarcinoma, Taiwan: Chueh et al. (2023); Pemigatinib versus mFOLFOX and versus fluorouracil in previously treated FGFR2 fusion-positive advanced intrahepatic cholangiocarcinoma, Taiwan: Chen et al. (2023); Ivosidenib versus mFOLFOX and versus fluorouracil with leucovorin in previously treated IDH1-mutant advanced intrahepatic cholangiocarcinoma, Taiwan: Chen et al. (2024a); 11 further articles. Utility weights: Utility weights for progression-free and progressed states, intravenous therapy, and grade 3 or higher adverse events, advanced intrahepatic cholangiocarcinoma: Chueh et al. (2023); Utility weights for progression-free and progressed states, intravenous therapy, and grade 3 or higher adverse events, advanced intrahepatic cholangiocarcinoma: Chen et al. (2023); Utility weights for progression-free and post-progression states, intravenous therapy, and grade 3 or higher adverse events, IDH1-mutant advanced intrahepatic cholangiocarcinoma: Chen et al. (2024a); Utility weights for progression-free and progressed cholangiocarcinoma: Chen et al. (2024b); 6 further articles. Every value is a verbatim quote from the primary article it is shown with." canonical: "https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/cost-effectiveness-analyses" published: "2026-10-22T07:49:06-04:00" modified: "2026-10-22T07:49:06-04:00" --- # Tovecimig (CTX-009) in Second-line advanced biliary tract cancer: cost-effectiveness analyses and utility weights Published cost-effectiveness analyses and health-state utility weights that a model of this product could cite, adapt, or compare against, grouped by how each article relates to the product and its indication. Every value is quoted from the article it cites, and section 3 lists the searches that found the articles. ## Overview | Item | Detail | | --- | --- | | Literature searched | Tufts Medical Center Cost-Effectiveness Analysis Registry, searched October 21, 2026; the queries are listed in section 3. | | Cost-effectiveness analyses | 15 | | Studies reporting utility weights | 10 | ## 1 Cost-effectiveness analyses ### 1.1 Analyses of Tovecimig (CTX-009 and ABL001) No evidence found. ### 1.2 Treatments for the same indication #### Pemigatinib versus mFOLFOX with active symptom control and versus active symptom control alone in relapsed or refractory FGFR2 fusion-positive cholangiocarcinoma, England: NICE TA722 committee discussion (2021) Relevance: Evaluates pemigatinib, an FGFR2 fusion-directed inhibitor listed in section 2, against mFOLFOX with active symptom control and against active symptom control alone in relapsed or refractory FGFR2 fusion-positive cholangiocarcinoma in a NICE technology appraisal for England, with FOLFOX the second-line standard of care in section 2. > “The company's partitioned survival model used parametric survival models to predict outcomes including time-on-treatment, progression-free survival and overall survival. The model included people in both the progression-free and post-progression health states, either on or off treatment.” > “It used a life-time horizon with a cycle length of 1 week. An annual discount rate of 3.5% was applied to costs and outcomes.” > “The committee noted that the company's new base-case ICERs for pemigatinib, including an updated patient access scheme, were £42,076 per QALY gained compared with mFOLFOX+ASC, and £45,029 per QALY gained compared with ASC alone.” > “Using these preferred assumptions, the ICER was between £45,051 and £45,808 per QALY gained compared with mFOLFOX+ASC, and between £44,354 and £45,010 per QALY gained compared with ASC alone.” > “For a life-extending treatment at the end of life, the upper limit of the range usually considered to represent a cost-effective use of NHS resources is £50,000 per quality-adjusted life year (QALY) gained.” > “It concluded that the cost-effectiveness estimates for pemigatinib suggest it is an acceptable use of NHS resources for a life-extending treatment at the end of life. So pemigatinib was recommended for routine use in the NHS.” Source: [NICE TA722 committee discussion (2021)](https://www.nice.org.uk/guidance/ta722/chapter/3-Committee-discussion) #### Biomarker-driven pemigatinib or mFOLFOX versus fluorouracil chemotherapy in previously treated advanced intrahepatic cholangiocarcinoma, Taiwan: Chueh et al. (2023) Relevance: Evaluates second-line treatment selected by FGFR2 status, pemigatinib or mFOLFOX, against fluorouracil chemotherapy in advanced intrahepatic cholangiocarcinoma in Taiwan, a second-line model for the FGFR2 fusion-positive subgroup that section 2 lists. > “This cost-effectiveness analysis evaluated the cost-effectiveness of the pemigatinib/mFOLFOX regimen as the second-line treatment for advanced intrahepatic cholangiocarcinoma based on FGFR2 status in comparison with the regimen of fluorouracil chemotherapy and provided a cost-effectiveness analysis-based reference price for pemigatinib.” > “A three-state partitioned survival model with a 5-year time horizon was constructed for patients with advanced intrahepatic cholangiocarcinoma who did not respond to first-line therapy.” > “The willingness-to-pay threshold was three times the gross domestic product per capita in 2021 (NT$2,889,684). A 3% discount rate was applied to quality-adjusted life-years and costs.” > “The new regimen provided an incremental 0.13 quality-adjusted life-years, with incremental costs of NT$459,697, yielding an incremental cost-effectiveness ratio of NT$3,411,098 per quality-adjusted life-year and an incremental net monetary benefit of - NT$70,268.” > “The new regimen was found to be 53.2% cost effective in the probabilistic sensitivity analysis.” > “In scenario analyses, the incremental net monetary benefit was positive when the price of pemigatinib was reduced by 40% or more.” Source: [Chueh et al. (2023)](https://pubmed.ncbi.nlm.nih.gov/36575331/) #### Pemigatinib versus mFOLFOX and versus fluorouracil in previously treated FGFR2 fusion-positive advanced intrahepatic cholangiocarcinoma, Taiwan: Chen et al. (2023) Relevance: Evaluates second-line pemigatinib against mFOLFOX and against fluorouracil chemotherapy in FGFR2 fusion-positive advanced intrahepatic cholangiocarcinoma from the perspective of Taiwan's National Health Insurance Administration, with FOLFOX the second-line standard of care named in section 2. > “This study aims to analyze the cost-effectiveness of pemigatinib 13.5 mg as a second-line treatment compared to mFOLFOX and 5-FU chemotherapy for advanced ICC patients with FGFR2 fusions/rearrangements from the perspective of Taiwan’s NHIA.” > “This study used a 3-state partitioned survival model to analyze the 5 year cost-effectiveness of pemigatinib as a second-line treatment for advanced ICC patients in whom first-line gemcitabine-based chemotherapy failed and to compare the results with those for the mFOLFOX and 5-FU chemotherapy regimens.” > “An annual discount of 3% was applied to health outcomes and costs.” > “Costs listed in 2022 Taiwan dollars” > “Pemigatinib was associated with a 0.59 QALY increase with incremental costs of NT$3,428,442 and a 0.68 QALY increase with incremental costs of NT$3,653,100, yielding an ICER of NT$5,814,700 per QALY and an ICER of NT$5,380,241 per QALY compared to mFOLFOX and 5-FU, respectively” > “pemigatinib was more effective but more expensive, resulting in a 6.5% and 4.6% probability of being cost-effective under a WTP threshold of 3 times the GDP per capita per QALY gained.” > “When the medication cost of pemigatinib was reduced by more than 50%, pemigatinib gained a positive INMB of NT$55,374 and NT$92,437, with a probability of 72.0% and 77.1% of being cost-effective, respectively” Source: [Chen et al. (2023)](https://pmc.ncbi.nlm.nih.gov/articles/PMC10496386/) #### Ivosidenib versus mFOLFOX and versus fluorouracil with leucovorin in previously treated IDH1-mutant advanced intrahepatic cholangiocarcinoma, Taiwan: Chen et al. (2024a) Relevance: Evaluates ivosidenib, the IDH1 inhibitor listed in section 2 for a molecular subgroup of second-line biliary tract cancer, against chemotherapy in previously treated advanced intrahepatic cholangiocarcinoma in Taiwan. > “we aimed to assess ivosidenib’s cost-effectiveness in previously treated, advanced ICC-presenting IDH1 mutations compared with mFOLFOX or 5-FU/LV.” > “A 3-state partitioned survival model was employed to assess ivosidenib’s cost-effectiveness over a 10-year horizon with a 3% discount rate, setting the willingness-to-pay threshold at 3 times the 2022 GDP per capita.” > “All analyses were conducted from the perspective of Taiwan NHIA.” > “Compared with mFOLFOX, ivosidenib yielded an incremental gain of 0.37 QALY at an incremental cost of NT$2,346,032. This resulted in an ICER of NT$6,268,528 per QALY and an INMB of NT$ − 1,251,116.” > “In comparison with the 5-FU/LV regimen, ivosidenib provided an incremental benefit of 0.44 QALY, incurring an incremental cost of NT$2,478,942 and resulting in an ICER of NT$5,670,555 per QALY and an associated INMB of NT$ − 1,199,993.” > “At NT$10,402/500 mg, ivosidenib was not cost-effective for IDH1 -mutant ICC patients compared with mFOLFOX or 5-FU/LV, indicating that a 50–60% price reduction is necessary for ivosidenib to be cost-effective in this patient group.” Source: [Chen et al. (2024a)](https://pmc.ncbi.nlm.nih.gov/articles/PMC11110281/) #### Pembrolizumab versus tumor-specific standard-of-care chemotherapy in previously treated MSI-H or dMMR cancers including cholangiocarcinoma, United States: Chen et al. (2024b) Relevance: Evaluates pembrolizumab, a tumor-agnostic therapy for MSI-H disease listed in section 2, against tumor-specific standard-of-care chemotherapy in previously treated MSI-H or dMMR cancers including cholangiocarcinoma from a United States commercial payer perspective. Access: Free full text > “We developed a partitioned survival model to evaluate the cost-utility of pembrolizumab for previously treated patients with 8 advanced or metastatic microsatellite instability-high or mismatch repair-deficient cancers from a US commercial payer perspective.” > “Eight chemotherapy-based external control arms were constructed from the TriNetX electronic health record databases.” > “We developed a partitioned survival model comprising 3 health states (ie, progression free, post progression, and death).” > “All costs and outcomes were discounted at an annual rate of 3%” > “All costs were adjusted to 2022 US dollars.” > “At a lifetime horizon, pembrolizumab was associated with increased effectiveness compared with chemotherapies in colorectal (quality-adjusted life years [QALYs]: +0.64, life years [LYs]: +0.64), endometrial (QALYs: +3.79, LYs: +5.47), and small intestine cancers (QALYs: +1.73, LYs: +2.48), but not for patients with metastatic gastric, cholangiocarcinoma, pancreatic, ovarian, and brain cancers.” > “Pembrolizumab was found to be cost-effective in treating colorectal and endometrial cancers (incremental cost-effectiveness ratios: $121 967 and $139 257, respectively), and not cost-effective for other assessed cancers at a $150 000 willingness-to-pay/QALY threshold, compared with SoC chemotherapies.” > “Pembrolizumab was considered less costly and less effective in treating metastatic brain cancer (ΔQALYs: −0.83, ΔCosts: −$170 770) and not cost-effective in treating other cancers (gastric, cholangiocarcinoma, pancreatic, small intestine, and ovarian).” Source: [Chen et al. (2024b)](https://doi.org/10.1016/j.jval.2024.03.010) | Tumor type | Treatment | Total costs | Total QALYs | Total LYs | ΔCosts | ΔQALYs | ΔLYs | Incremental cost per QALY gained | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | “Cholangiocarcinoma” | “Pembro” | “$321 470” | “1.49” | “2.15” | “$119 408” | “−0.06” | “−0.06” | “Less effective, more costly” | | “Cholangiocarcinoma” | “Chemo” | “$202 062” | “1.55” | “2.21” | | | | | Source: [Chen et al. (2024b)](https://doi.org/10.1016/j.jval.2024.03.010) #### Pembrolizumab versus standard of care in previously treated MSI-H/dMMR solid tumours including biliary tract cancer, United Kingdom: McCarthy et al. (2024) Relevance: Evaluates pembrolizumab, a tumor-agnostic therapy for MSI-H disease listed in section 2, against standard of care in previously treated MSI-H solid tumors including cholangiocarcinoma in the United Kingdom. Access: Free full text Not quoted: The text of the full article reports results for the pooled tumour sites and states no result for biliary tract cancer alone. > “This study evaluated the cost-effectiveness of pembrolizumab compared with standard of care (SoC) for previously treated MSI-H/dMMR solid tumours in line with the approved EMA label from a UK healthcare payer perspective.” > “A multi-tumour partitioned survival model was built consisting of pre-progression, progressed disease, and dead health states.” > “Tumour sites were modelled independently and then combined, weighted by tumour site distribution.” > “Pembrolizumab, at list price, was associated with £129,469 in total costs, 8.30 LYs, and 3.88 QALYs across the pooled tumour sites.” > “SoC was associated with £28,222 in total costs, 1.14 LYs, and 0.72 QALYs across the pooled tumour sites. This yields an incremental cost-effectiveness ratio (ICER) of £32,085 per QALY.” Source: [McCarthy et al. (2024)](https://pubmed.ncbi.nlm.nih.gov/38293714/) ### 1.3 The same disease in other populations or settings #### Durvalumab versus pembrolizumab, each with gemcitabine and cisplatin, in first-line advanced biliary tract cancer, United States and China: Zhu et al. (2023) Relevance: Compares durvalumab and pembrolizumab, each given with gemcitabine and cisplatin, as first-line treatment of advanced biliary tract cancer from United States and Chinese healthcare system perspectives, the first-line therapy that precedes the second-line setting of COMPANION-002. Access: Free full text > “the cost-effectiveness comparison of first-line durvalumab or pembrolizumab plus gemcitabine and cisplatin (GemCis) treatment of aBTC was explored from the perspective of American and Chinese healthcare systems.” > “Ground on the TOPAZ-1 and KEYNOTE-966 trials, the Markov model with a 15-year horizon including three health states to imitate cost and effective outcomes was established.” > “Total costs and health values were discounted at respective rates of 3% and 5% annually in the USA and China.” > “Incremental cost-effectiveness ratio (ICER) at willingness-to-pay (WTP) thresholds of $100 000/QALY and $37 408/ALY in the USA and China was used as the most important indicator.” > “Durvalumab plus GemCis ($322 211 [2.94 QALYs] and $35 695 [2.76 QALYs]) increased cost (effectiveness) by $63 777 (.22 QALYs) and $5234 (.20 QALYs) than pembrolizumab plus GemCis ($258 434 [2.72 QALYs] and $30 461 [2.56 QALYs]) in the USA and China, respectively.” > “The corresponding ICER was $288 725/QALY and $26 401/QALY, with INHB of −.42 and .06 QALYs, respectively.” > “In China, first-line durvalumab plus GemCis versus pembrolizumab plus GemCis was a cost-effective option for patients with aBTC, but not in the USA.” Source: [Zhu et al. (2023)](https://doi.org/10.1111/liv.15699) #### Durvalumab plus gemcitabine and cisplatin versus gemcitabine and cisplatin in first-line advanced biliary tract cancer, United States and China: Ye et al. (2023) Relevance: Evaluates durvalumab added to gemcitabine and cisplatin, the TOPAZ-1 regimen listed in section 2 as first-line treatment, against gemcitabine and cisplatin in advanced biliary tract cancer in the United States and China. > “The aim of this study was to assess the cost effectiveness of durvalumab plus chemotherapy compared to placebo plus chemotherapy from the perspective of US and Chinese payers.” > “Based on clinical data from the TOPAZ-1 trial, a Markov model was developed to simulate 10-year life expectancy and total healthcare costs for patients with BTC.” > “This research was based on the perspective of Chinese and US payers, applying discount rates of 3% and 5% to costs and utilities, respectively” > “For US payers, we set the willing to pay (WTP) threshold to $150,000/QALY.” > “For US payers, the placebo plus chemotherapy group had a total cost of $56,157.05 and a utility of 1.10 QALYs, while the durvalumab plus chemotherapy group had a total cost of $217,069.25, a utility of 1.52 QALYs, resulting in an ICER of $381,864.39/QALY.” > “From the perspective of the Chinese payers, compared to the chemotherapy group, the durvalumab plus chemotherapy group incurred an additional cost of $154,904.98, resulting in an ICER of 367,608.51 /QALY” > “For US and Chinese payers, under the respective willing to pay thresholds, the likelihood of the durvalumab plus chemotherapy arm being cost-effective was 0%.” Source: [Ye et al. (2023)](https://pmc.ncbi.nlm.nih.gov/articles/PMC9950513/) #### Pembrolizumab plus chemotherapy versus placebo plus chemotherapy in first-line advanced biliary tract cancer, United States and China: Jiang et al. (2025) Relevance: Evaluates pembrolizumab plus chemotherapy against placebo plus chemotherapy in first-line advanced biliary tract cancer from United States and Chinese payer perspectives, the first-line setting in which section 2 lists the KEYNOTE-966 regimen. > “This study aimed to evaluate the cost-effectiveness of pembrolizumab plus chemotherapy compared with placebo plus chemotherapy from the perspective of US and Chinese payers.” > “The models included three health states: PFS, progressive disease (PD) and death” > “Each treatment cycle was set at 3 weeks, and a 10-year time horizon with half-cycle correction was applied based on the previous data about BTC.” > “Costs and QALYs were discounted at an annual rate of 3%. The willingness-to-pay (WTP) threshold was set at three times the gross domestic product per capita, resulting in US$210,746/QALY for the USA and $37,669/QALY for China.” > “The treatment increased costs by US$97 222.13 in the US and $43 312.02 in China, resulting in ICERs of US$810 184.42 and $360 933.50 per QALY, respectively.” > “Further analyses suggested that the optimal price of pembrolizumab in the USA would be nearly US$10.33 /mg, while a price reduction of over 90% would be required for the combined therapy to be cost-effective for patients in China.” Source: [Jiang et al. (2025)](https://pmc.ncbi.nlm.nih.gov/articles/PMC12020752/) #### Pembrolizumab plus chemotherapy versus chemotherapy alone in first-line advanced biliary tract cancer, United States and China: Zhang et al. (2026) Relevance: Evaluates pembrolizumab with chemotherapy against chemotherapy alone in advanced biliary tract cancer from United States and Chinese perspectives, the first-line KEYNOTE-966 regimen listed in section 2. > “We constructed a partitioned survival model form the perspectives of US and Chinese payers. KEYNOTE-966 was used to obtain the baseline characteristics of the patients as well as their clinical data.” > “There were deaths in more than 98% of patients in both treatment arms with a 10-year time horizon, which means we considered it a lifetime study” > “In China, costs (converted to US dollars) and utilities were discounted at 5%, whereas in the United States, both costs and utilities were discounted at 3%” > “Based on comparison of the ICER between pembrolizumab plus chemotherapy and chemotherapy alone, the ICER for pembrolizumab plus chemotherapy was $466,340 per QALY (> WTP of $84,866) and $976,925/QALY (> WTP of $150,000) for the China and the US, respectively.” > “In addition, we performed an alternative analysis focusing only on PFS. In China and the US, the ICER for pembrolizumab plus chemotherapy compared with that of chemotherapy alone was $535,405/QALY and $1,118,607/QALY.” > “Moreover, for pembrolizumab plus chemotherapy, the INHB was −0.616 QALYs and the INMB was -$52,237 when the WTP threshold for China was $84,866 per QALY, and for US, the INHB was −0.796 QALYs and the INMB was -$119,400.” Source: [Zhang et al. (2026)](https://pmc.ncbi.nlm.nih.gov/articles/PMC12826477/) #### Pembrolizumab plus gemcitabine and cisplatin versus gemcitabine and cisplatin in first-line advanced biliary tract cancer, China, Japan, United States, and Switzerland: Xie et al. (2025) Relevance: Evaluates first-line pembrolizumab with chemotherapy against chemotherapy alone in advanced biliary tract cancer in the United States, China, Japan, and Switzerland. > “This study employs a partitioned survival analysis model (PartSA) to conduct a cross-country cost-effectiveness evaluation, incorporating treatment cost and utility data from China, Japan, the United States, and Switzerland.” > “The model employed a 21-day cycle and a time horizon of 10 years, by which point nearly all patients in both groups had transitioned to the death state.” > “Discount rates for costs and utilities were established at 5% for China ( 17 ), 3% for Japan ( 18 ), 3% for the United States ( 19 ), and 3% for Switzerland” > “Compared to chemotherapy alone, the additional costs for combination therapy in China, Japan, the United States, and Switzerland were $74,621.78, $44,014.83, $160,169.86, and $163,631.09, respectively; the QALY gains were 0.14, 0.14, 0.14, and 0.15, respectively. The cost per additional QALY gained was $542,441.16, $314,213.67, $1,104,628.40, and $1,069,496.82, respectively.” > “When comparing the ICER values of the four countries with their respective WTP thresholds, the results indicated that the ICER values for combination therapy were significantly higher than the WTP thresholds in all four countries” > “In the United States, Japan, and Switzerland, an 80–95% reduction in pembrolizumab’s price was necessary for cost-effectiveness, while in China, a reduction greater than 95% was required.” Source: [Xie et al. (2025)](https://pmc.ncbi.nlm.nih.gov/articles/PMC12375827/) #### Gemcitabine plus cisplatin versus gemcitabine monotherapy in advanced biliary tract cancer, United States: Roth and Carlson (2012) Relevance: Evaluates gemcitabine with cisplatin against gemcitabine monotherapy in advanced biliary tract cancer in the United States, the chemotherapy backbone of the first-line regimens listed in section 2. > “Based on the ABC-02 findings, this analysis seeks to evaluate the cost-utility of adding cisplatin to standard gemcitabine therapy from a U.S. societal perspective.” > “A decision-analytic model was developed to estimate direct medical costs, patient time costs, and quality-adjusted life-years (QALYs) for two treatment strategies: (1) gemcitabine + cisplatin, (2) gemcitabine monotherapy.” > “Total QALYs for the gemcitabine + cisplatin and gemcitabine monotherapy strategies were 0.751 and 0.561, respectively. Total costs were $44,885 and $33,653 respectively.” > “Relative to gemcitabine monotherapy, gemcitabine + cisplatin had an incremental cost-effectiveness ratio (ICER) of $59,480 per QALY gained.” > “In the PSA, gemcitabine monotherapy had the highest probability of being cost-effective until a willingness-to-pay of $60,000, after which the gemcitabine + cisplatin strategy had the highest probability.” Source: [Roth and Carlson (2012)](https://pubmed.ncbi.nlm.nih.gov/21234709/) ### 1.4 Related diseases and analogous treatments #### Paclitaxel plus ramucirumab, paclitaxel, ramucirumab, docetaxel, irinotecan, and palliative care as second-line treatment of advanced gastric cancer, United States: Lam et al. (2017) Relevance: Compares second-line options for advanced gastric cancer from a United States third-party payer perspective, including paclitaxel plus ramucirumab, an antiangiogenic antibody, against paclitaxel alone, the comparison COMPANION-002 makes with tovecimig. > “Cost-effectiveness analysis using a Markov model to compare the cost-effectiveness of six possible second-line treatment options for patients with advanced gastric cancer who have failed previous chemotherapy: irinotecan, docetaxel, paclitaxel, ramucirumab, paclitaxel plus ramucirumab, and palliative care.” > “The model was performed from a third-party payer's perspective to compare lifetime costs and health benefits associated with studied second-line therapies.” > “Irinotecan had the lowest lifetime cost and was associated with a QALY gain of 0.35 year. Docetaxel, ramucirumab alone, and palliative care were dominated strategies.” > “Paclitaxel and the combination of paclitaxel plus ramucirumab led to higher QALYs gained, at an incremental cost of $86,815 and $1,056,125 per QALY gained, respectively.” > “PSA illustrated that paclitaxel plus ramucirumab was extremely unlikely to be cost-effective at a WTP threshold less than $400,000/QALY gained.” Source: [Lam et al. (2017)](https://pubmed.ncbi.nlm.nih.gov/27870079/) #### Paclitaxel plus ramucirumab versus paclitaxel in advanced gastric cancer progressing after first-line chemotherapy, Japan: Saito et al. (2017) Relevance: Evaluates ramucirumab, an antiangiogenic antibody, added to paclitaxel against paclitaxel monotherapy in gastric cancer progressing after first-line chemotherapy in Japan, a comparison with the same structure as the COMPANION-002 arms. > “We evaluated the cost-effectiveness of paclitaxel + ramucirumab combination therapy in patients with advanced gastric cancer, from the perspective of health care payers in Japan.” > “We constructed a Markov model to compare, over a time horizon of 3 years, the costs and effectiveness of the combination of paclitaxel + ramucirumab and paclitaxel alone as second-line therapies for advanced gastric cancer in Japan.” > “Costs were calculated using year-2016 Japanese yen (¥1 = US $17.79) according to the social insurance reimbursement schedule and drug tariff of the fee-for-service system in Japan.” > “The costs and QALYs were discounted at a rate of 2% per year.” > “Paclitaxel + ramucirumab combination therapy was estimated to provide an additional 0.09 QALYs (0.10 LYs) at a cost of ¥3,870,077, resulting in an incremental cost-effectiveness ratio of ¥43,010,248/QALY.” > “The incremental cost-effectiveness ratio for the combination therapy was >¥12 million/QALY in all of the 1-way and probabilistic sensitivity analyses.” Source: [Saito et al. (2017)](https://pubmed.ncbi.nlm.nih.gov/29175097/) #### Paclitaxel, ramucirumab plus paclitaxel, pembrolizumab, and biomarker-guided strategies versus best supportive care as second-line treatment of metastatic gastric cancer, United States: Lauren et al. (2020) Relevance: Compares pembrolizumab monotherapy, ramucirumab plus paclitaxel, biomarker-guided strategies, paclitaxel monotherapy, and best supportive care as second-line treatment of metastatic gastric cancer from a United States payer perspective, with paclitaxel the control arm of COMPANION-002. > “We constructed a Markov decision-analytic model using clinical trial data. Our model compared pembrolizumab monotherapy and ramucirumab/paclitaxel combination therapy for all patients and pembrolizumab for patients based on MSI status or PD-L1 expression. Paclitaxel monotherapy and best supportive care for all patients were additional comparators.” > “Costs of drugs, treatment administration, follow-up, and management of adverse events were estimated from a US payer perspective.” > “The model simulated a 60-month treatment and follow-up window, or 5-year time horizon, in monthly cycles.” > “All costs and utility scores were discounted by 3% annually” > “ICERs were calculated as the ratio of differences in costs and QALYs between a strategy and the next best alternative. A willingness-to-pay (WTP) threshold of $100,000 per QALY gained was used in the base case as the cutoff for cost effectiveness” > “PAC for all patients was the only cost-effective strategy, with an ICER of $53705/QALY. PEM for MSI-H patients and PAC for MSS patients resulted in an ICER of $325611/QALY, and PEM for MSI-H patients and RAM/PAC for MSS patients resulted in an ICER of $1074620/QALY.” Source: [Lauren et al. (2020)](https://pmc.ncbi.nlm.nih.gov/articles/PMC7048937/) | Strategy | ICER | | --- | --- | | “PAC, all” | “53705” | | “PEM all” | “Dominated” | | “RAM/PAC all” | “Dominated” | | “MSI-H: PEM MSS: PAC” | “325611” | | “MSI-H: PEM MSS: RAM/PAC” | “1074620” | Source: [Lauren et al. (2020)](https://pmc.ncbi.nlm.nih.gov/articles/PMC7048937/) ## 2 Utility weights ### 2.1 Utility weights from analyses of Tovecimig (CTX-009 and ABL001) No evidence found. ### 2.2 Utility weights for the same indication #### Utility weights for progression-free and progressed states, intravenous therapy, and grade 3 or higher adverse events, advanced intrahepatic cholangiocarcinoma: Chueh et al. (2023) Relevance: Utilities for the progression-free and disease-progressed states of advanced intrahepatic cholangiocarcinoma in a second-line model, with disutilities for intravenous therapy and for severe adverse events. Access: Not open access Not quoted: The utility weights are reported in the full text, which is closed access. > “The utility of health states and disutility of adverse events were obtained from the literature.” Source: [Chueh et al. (2023)](https://pubmed.ncbi.nlm.nih.gov/36575331/) #### Utility weights for progression-free and progressed states, intravenous therapy, and grade 3 or higher adverse events, advanced intrahepatic cholangiocarcinoma: Chen et al. (2023) Relevance: Utilities for the progression-free and post-progression states of advanced intrahepatic cholangiocarcinoma treated in the second line, with disutilities for intravenous therapy and for severe adverse events. > “As there is currently no evidence of utility or disutility due to adverse events for advanced ICC patients, this study used the same approach as NICE technology appraisal guidance” > “Health state utility values for the PF state and PD state were 0.76 and 0.68, respectively, and were assumed to be beta distributions” > “Disutility due to adverse events was 0.16” > “disutility in patients who received subcutaneous or intravenous therapies (comparators) was 0.025” Source: [Chen et al. (2023)](https://pmc.ncbi.nlm.nih.gov/articles/PMC10496386/) #### Utility weights for progression-free and post-progression states, intravenous therapy, and grade 3 or higher adverse events, IDH1-mutant advanced intrahepatic cholangiocarcinoma: Chen et al. (2024a) Relevance: Utilities for the progression-free and post-progression states of previously treated IDH1-mutant advanced intrahepatic cholangiocarcinoma, with disutilities for intravenous therapy and for severe adverse events. > “In the absence of published utility and disutility data specific to patients with ICC, this study followed NICE’s technology appraisal guidance (TA722 and TA474)” > “The assigned utility values for each health state in our model were 0.76 for the PF state and 0.68 for the PP state.” > “we drew upon disutility values of adverse events from patients with metastatic renal carcinoma, which had been employed in a prior hepatocellular carcinoma study” > “We set the disutility values for adverse events at 0.16 and subcutaneous or intravenous therapies at 0.025.” Source: [Chen et al. (2024a)](https://pmc.ncbi.nlm.nih.gov/articles/PMC11110281/) #### Utility weights for progression-free and progressed cholangiocarcinoma: Chen et al. (2024b) Relevance: Utilities for the progression-free and progressive disease states of previously treated cholangiocarcinoma from a United States model of pembrolizumab. Access: Free full text > “Tumor-specific health-state utility values were applied.” Source: [Chen et al. (2024b)](https://doi.org/10.1016/j.jval.2024.03.010) | Health state | Utility | | --- | --- | | “Progression-free, cholangiocarcinoma” | “0.77” | | “Progressive disease, cholangiocarcinoma” | “0.67” | Source: [Chen et al. (2024b)](https://doi.org/10.1016/j.jval.2024.03.010) #### Utility weights before and after progression, previously treated MSI-H/dMMR cholangiocarcinoma: McCarthy et al. (2024) Relevance: Utilities before and after progression in previously treated cholangiocarcinoma from a United Kingdom model of pembrolizumab. Access: Free full text Not quoted: The utility weights are reported in Table 1 of the full text, which the publisher’s page displays only on request, so this page does not quote them. Source: [McCarthy et al. (2024)](https://pubmed.ncbi.nlm.nih.gov/38293714/) ### 2.3 Utility weights for the same disease in other populations or settings #### Utility weights for progression-free and progressed states and grade 3 or higher adverse events, advanced biliary tract cancer: Zhu et al. (2023) Relevance: Utilities for the progression-free and progressed states of advanced biliary tract cancer and a disutility for severe adverse events, from a model of first-line chemoimmunotherapy. Access: Free full text > “As details regarding patient QoL or efficacy were not available from the trials used to conduct the present analysis, the PFS and PD states were assigned respective utility values of .76 and .68 based on prior studies focused on aBTC.” > “Grade 3 or higher treatment-associated adverse events (AEs) were assigned a mean disutility value of .073 as a means of assessing deteriorating patient QoL” Source: [Zhu et al. (2023)](https://doi.org/10.1111/liv.15699) | Health state | Utility | | --- | --- | | “Utility of PFS” | “.760 (.608–.912)” | | “Utility of PD” | “.680 (.544–.816)” | | “Disutility of AEs (≥grade 3)” | “.073 (.058–.087)” | Source: [Zhu et al. (2023)](https://doi.org/10.1111/liv.15699) #### Utility weights for progression-free and progressed states and disutilities for hematologic adverse events, advanced biliary tract cancer: Ye et al. (2023) Relevance: Utilities for the progression-free and progressed states of advanced biliary tract cancer and disutilities for leukopenia, anemia, neutropenia, and thrombocytopenia, from a model of durvalumab with chemotherapy. > “We were unable to obtain specific utility values for the patients with PFS and PD status. We used data from previously published studies as the health utility of BTCs patients in PFS and PD states (0.76 for PFS and 0.68 for PD)” Source: [Ye et al. (2023)](https://pmc.ncbi.nlm.nih.gov/articles/PMC9950513/) | Health state | Utility | | --- | --- | | “Leukopenia” | “−0.09” | | “Anemia” | “−0.125” | | “Neutropenia” | “−0.09” | | “Thrombocytopenia” | “−0.20” | Source: [Ye et al. (2023)](https://pmc.ncbi.nlm.nih.gov/articles/PMC9950513/) #### Utility weights for progression-free and progressed states, advanced biliary tract cancer, United States and China: Jiang et al. (2025) Relevance: Utilities for the progression-free and progressive disease states of advanced biliary tract cancer applied to the United States and China. > “Health utility values, although measured using the European Organisation for Research and Treatment of Cancer 30-Item Core Quality of Life Questionnaire in the original study, were not disclosed. Therefore, published data were used to assign a utility score of 0.76 for PFS, 0.68 for PD and 0 for death” Source: [Jiang et al. (2025)](https://pmc.ncbi.nlm.nih.gov/articles/PMC12020752/) #### Utility weights for progression-free and progressed states by country, advanced biliary tract cancer: Xie et al. (2025) Relevance: Country-specific utilities for the progression-free and progressed states of advanced biliary tract cancer for the United States, China, Japan, and Switzerland. > “utility values for different health states and disutility values for AEs, were obtained from published literature.” Source: [Xie et al. (2025)](https://pmc.ncbi.nlm.nih.gov/articles/PMC12375827/) | Health state | China | Japan | United States | Switzerland | | --- | --- | --- | --- | --- | | “PFS” | “0.76” | “0.73” | “0.76” | “0.80” | | “PD” | “0.68” | “0.69” | “0.68” | “0.73” | Source: [Xie et al. (2025)](https://pmc.ncbi.nlm.nih.gov/articles/PMC12375827/) #### Utility weights before and after progression and with an adverse event, advanced biliary tract cancer: Roth and Carlson (2012) Relevance: Utilities for advanced biliary tract cancer before and after progression and with an adverse event, from a United States model of gemcitabine-based chemotherapy. Access: Not open access Not quoted: The utility weights are reported in the full text, which is closed access. > “One-way sensitivity analyses found results to be sensitive to progression-free survival, overall survival, pre and post-progression health state utility values, and the cost of post-progression care.” Source: [Roth and Carlson (2012)](https://pubmed.ncbi.nlm.nih.gov/21234709/) ### 2.4 Utility weights for related diseases and analogous treatments No evidence found. ## 3 Search strategy | Dataset | Query | Results | | --- | --- | --- | | Methods | tovecimig OR "CTX-009" OR ABL001 | 0 | | Ratios | cholangiocarcinoma OR "biliary tract" OR "bile duct" OR "gallbladder" | 119 | | Ratios | futibatinib OR pemigatinib OR infigratinib OR erdafitinib | 5 | | Ratios | ivosidenib OR zanidatamab OR "liposomal irinotecan" | 4 | | Methods | cholangiocarcinoma OR "biliary tract cancer" OR "biliary cancer" OR "gallbladder cancer" | 30 | | Methods | "fibroblast growth factor receptor" OR FGFR | 2 | | Methods | ramucirumab AND paclitaxel | 6 | | Methods | FOLFOX AND (cholangiocarcinoma OR biliary) | 2 | | Methods | "active symptom control" OR "best supportive care" AND biliary | 1 | | Methods | ramucirumab | 13 | | Methods | bevacizumab AND paclitaxel | 18 | | Weights | cholangiocarcinoma OR "biliary tract" OR "biliary cancer" OR "gallbladder cancer" | 123 | | Methods | paclitaxel AND (biliary OR cholangiocarcinoma) | 0 | | Methods | "DLL4" OR "delta-like ligand 4" OR "bispecific antibody" | 10 | ## Related pages - [Tovecimig (CTX-009): Second-line advanced biliary tract cancer](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer) · [Markdown](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer.md) - [Tovecimig (CTX-009) in Second-line advanced biliary tract cancer: Terms and abbreviations](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/terms-and-abbreviations) · [Markdown](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/terms-and-abbreviations.md) - [Tovecimig (CTX-009): Second-line advanced biliary tract cancer](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/executive-summary) · [Markdown](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/executive-summary.md) - [Tovecimig (CTX-009) in Second-line advanced biliary tract cancer: Product information and disease description](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/product-information-and-disease-description) · [Markdown](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/product-information-and-disease-description.md) - [Tovecimig (CTX-009) in Second-line advanced biliary tract cancer: Clinical evidence](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/clinical-evidence) · [Markdown](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/clinical-evidence.md) - [Tovecimig (CTX-009) in Second-line advanced biliary tract cancer: Economic information and modeling report](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/economics) · [Markdown](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/economics.md) - [Tovecimig (CTX-009) in Second-line advanced biliary tract cancer: References](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/references) · [Markdown](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/references.md) - [Tovecimig (CTX-009) in Second-line advanced biliary tract cancer: formulary monograph](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/monograph) · [Markdown](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/monograph.md) - [Tovecimig (CTX-009) in Second-line advanced biliary tract cancer: drug evaluation](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/monograph/oregon) · [Markdown](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/monograph/oregon.md) - [Tovecimig (CTX-009) in Second-line advanced biliary tract cancer: prevalence by geography](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/prevalence) · [Markdown](https://www.evicenter.com/drugs/tovecimig--second-line-advanced-biliary-tract-cancer/prevalence.md)