Summary

No budget impact model, cost-effectiveness analysis, or health technology assessment of tovecimig was identified, and no price for tovecimig has been announced. Compass Therapeutics guides to a Biologics License Application submission in the fourth quarter of 2026 and to potential approval and launch in 2027, and states that launch preparation for a focused United States biliary tract cancer market is under way. The company puts the addressable United States market in second-line biliary tract cancer at more than $3 billion. It reported $180 million in cash, cash equivalents and marketable securities at June 30, 2026, expected to fund operations into 2028, and $209 million at December 31, 2025, and states that it would incur significant commercialization expenses if tovecimig were approved. Under the license agreement covering tovecimig, ABL Bio has received a $5 million upfront payment and a $6 million milestone payment and is eligible for up to $96 million in development and regulatory milestones, up to $303 million in commercial milestones, and tiered single-digit royalties on net sales in oncology, with a further $75 million in development and regulatory milestones and $110 million in commercial milestones in ophthalmology. South Korean rights are held by Handok and China rights were sublicensed to Elpiscience, with a 15% sublicense royalty due to ABL Bio.

The modeling context for the indication comes from published economic evaluations of other systemic therapies in advanced biliary tract cancer and from one health technology assessment of a second-line therapy. A systematic review of 20 economic studies published between January 2010 and March 2025 found that conventional chemotherapy regimens generally produced more favorable economic results than newer systemic therapies, that first-line immunotherapy combinations and biomarker-directed targeted therapies frequently produced incremental cost-effectiveness ratios above jurisdiction-specific willingness-to-pay thresholds, and that no dedicated peer-reviewed cost-effectiveness analysis of FOLFOX versus active symptom control in biliary tract cancer was identified. From a United States payer perspective, durvalumab added to gemcitabine and cisplatin produced an incremental cost-effectiveness ratio of $381,864.39 per quality-adjusted life-year for a gain of 0.42 quality-adjusted life-years, and pembrolizumab added to chemotherapy produced $976,925 per quality-adjusted life-year for a gain of 0.144 quality-adjusted life-years, both above the $150,000 per quality-adjusted life-year threshold applied. The National Institute for Health and Care Excellence recommended zanidatamab for HER2-positive advanced biliary tract cancer after at least one line of systemic treatment in May 2026, with FOLFOX plus active symptom control and active symptom control alone as the comparators and with an acceptable incremental cost-effectiveness ratio set towards the upper end of the £25,000 to £35,000 per quality-adjusted life-year range; the list price and the size of the commercial discount are confidential.

Economic model, cost-effectiveness analysis, or health technology assessment of tovecimig

No evidence found.

Analyst or market-research revenue forecast for tovecimig in biliary tract cancer

“According to DelveInsight's analysis, by 2034, among therapies, the highest revenue is expected to be generated by chemotherapy, followed by durvalumab (IMFINZI) and tovecimig in the 7MM.” (opens the source at this quote in a new tab)
“The United States accounted for the largest biliary tract cancer treatment market size, approximately 60% of the total market size in the 7MM in 2024, compared to other major markets, including the EU4 countries (Germany, France, Italy, and Spain), the United Kingdom, and Japan.” (opens the source at this quote in a new tab)

Measure	Reported value
Biliary tract cancer market size in the seven major markets in 2024	“USD 1.1 Billion”

Company estimate of the addressable United States market for tovecimig

“$3B+ addressable US market in 2L BTC” (opens the source at this quote in a new tab)
“Treatment Landscape Allows for a Targeted Launch in a Potential Total Addressable Market (TAM) of Over $3 Billion” (opens the source at this quote in a new tab)
“Highly focused US BTC market; targeted launch prep underway” (opens the source at this quote in a new tab)
“Substantial ex - US opportunities with higher incidence” (opens the source at this quote in a new tab)

Company plans for commercialization and commercialization expenditure

“We hold worldwide rights to all of our product candidates (with the exception of limited countries for tovecimig), which provide us the optionality to grow our internal pipeline independently or partner selected rights to our product candidates in different geographies throughout the world.” (opens the source at this quote in a new tab)
“Subject to receiving marketing approval, we intend to maximize the value of our product candidates by either independently planning to pursue the commercialization of our products in one or more major geographies by building an internal sales and marketing organization, or by seeking collaborations with third parties with commercialization infrastructure.” (opens the source at this quote in a new tab)

“We expect that we will require additional funding to complete the clinical development of these programs including the payment of developmental milestones, commercializing our product candidates, if we receive regulatory approval, and pursuing in-licenses or acquisitions of other product candidates.” (opens the source at this quote in a new tab)
“If we receive regulatory approval for tovecimig, CTX-471, CTX-8371, CTX-10726 or other product candidates, we expect to incur significant commercialization expenses related to product manufacturing, sales, marketing and distribution, depending on where we choose to commercialize these product candidates ourselves.” (opens the source at this quote in a new tab)

Cash position and runway

“As of June 30, 2026, we had $180 million in cash, cash equivalents and marketable securities. We expect that such cash resources will enable us to fund our operating expenses and capital expenditure requirements into 2028.” (opens the source at this quote in a new tab)

“$209 million in cash and marketable securities at year end 2025, which is expected to fund operations into 2028.” (opens the source at this quote in a new tab)

“The Company expects that its cash, cash equivalents and marketable securities will be sufficient to fund its operating expenses and capital expenditure requirements into 2028. The future viability of the Company beyond that point is dependent on its ability to raise additional capital to finance its operations.” (opens the source at this quote in a new tab)

Partnership economics for tovecimig: ABL Bio milestone and royalty terms

“We have licensed exclusive global rights to tovecimig, outside of South Korea, from ABL Bio, Inc.” (opens the source at this quote in a new tab)
“ABL Bio received a $5 million upfront payment and a $6 million milestone payment. In addition, ABL Bio is eligible to receive up to $96 million of development and regulatory milestone payments, up to $303 million of commercial milestone payments and tiered single-digit royalties on net sales of tovecimig in oncology.” (opens the source at this quote in a new tab)
“ABL Bio is also eligible to receive up to $75 million in development and regulatory milestone payments and up to $110 million in commercial milestone payments and tiered, single-digit royalties on net sales of tovecimig in ophthalmology.” (opens the source at this quote in a new tab)
“The financial terms of the agreement were amended in May 2021 but remain substantially similar to the terms in the TRIGR License Agreement.” (opens the source at this quote in a new tab)

Partnership economics for tovecimig: territory rights and sublicense royalty

“The licensing revenue consisted of a $1 million milestone payment from Elpiscience for completing a Phase 1 trial in China.” (opens the source at this quote in a new tab)
“This license revenue is reported net of a 15% sublicense royalty due to ABL Bio” (opens the source at this quote in a new tab)

Systematic review of published economic evidence in biliary tract cancer

“Twenty studies were included: 13 cost-effectiveness or cost–utility analyses and seven cost-of-illness or resource-use studies.” (opens the source at this quote in a new tab)
“First-line immunotherapy combinations and biomarker-directed targeted therapies frequently produced ICERs above jurisdiction-specific willingness-to-pay thresholds at current prices, often requiring substantial price reductions to approach cost-effectiveness.” (opens the source at this quote in a new tab)
“Real-world studies showed high resource use and costs, particularly with hospitalizations and later treatment lines.” (opens the source at this quote in a new tab)
“A central finding is that most current-price immunotherapies and targeted agents were not cost-effective in the jurisdictions studied.” (opens the source at this quote in a new tab)

Economic evidence specific to the second-line setting in biliary tract cancer

“The second-line economic literature was relatively sparse and concentrated on biomarker-selected therapies rather than on cytotoxic chemotherapy.” (opens the source at this quote in a new tab)
“we did not identify a dedicated peer-reviewed cost-effectiveness analysis of FOLFOX versus active symptom control in BTC” (opens the source at this quote in a new tab)
“Overall, the second-line evidence supports a cautious interpretation: targeted agents may offer clinically relevant options for molecularly selected patients, but at current prices, they have generally not been shown to be cost-effective in the jurisdictions studied.” (opens the source at this quote in a new tab)

Health technology assessment of a second-line therapy for advanced biliary tract cancer in England

“There is enough evidence to show that zanidatamab provides benefits and value for money, so it can be used routinely across the NHS in this population.” (opens the source at this quote in a new tab)
“If further treatment is suitable, people usually have FOLFOX chemotherapy with active symptom control (ASC). If this is not suitable, people usually have ASC only.” (opens the source at this quote in a new tab)

“The committee concluded that FOLFOX plus ASC, or ASC alone, were the relevant comparators for zanidatamab.” (opens the source at this quote in a new tab)
“The committee concluded that an acceptable ICER would be towards the upper end of the range NICE considers a cost-effective use of NHS resources (£25,000 to £35,000 per QALY gained).” (opens the source at this quote in a new tab)
“The committee was satisfied that its preferred assumptions produced an ICER that was within the range that NICE considers to be a cost-effective use of NHS resources.” (opens the source at this quote in a new tab)

Cost-effectiveness analysis of first-line durvalumab added to gemcitabine and cisplatin from a United States payer perspective

“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.” (opens the source at this quote in a new tab)
“For US payers, we set the willing to pay (WTP) threshold to $150,000/QALY.” (opens the source at this quote in a new tab)
“Both in China and in the US, durvalumab in combination with chemotherapy is not a cost-effective option for the first-line treatment of BTC compared with chemotherapy.” (opens the source at this quote in a new tab)

Cost-effectiveness analysis of first-line pembrolizumab added to chemotherapy from a United States payer perspective

“In the US, this treatment was not cost-effective, resulting in an improvement in effectiveness of 0.144 QALYs and an increase in overall cost of $141,000 (ICER of $976,925).” (opens the source at this quote in a new tab)
“In the US, the WTP threshold was set at $150,000” (opens the source at this quote in a new tab)

Cost-effectiveness analyses of second-line targeted therapy in intrahepatic cholangiocarcinoma

“Pemigatinib was not cost-effective at the hypothesized price of NT $17,820/13.5 mg.” (opens the source at this quote in a new tab)
“The ICER versus mFOLFOX and 5-FU was NT $3,411,098/QALY” (opens the source at this quote in a new tab)
“ICER vs. mFOLFOX: NT $6,268,528/QALY; vs. 5-FU/LV: NT $5,670,555/QALY” (opens the source at this quote in a new tab)

Cost-effectiveness analysis of ivosidenib in previously treated IDH1 mutant cholangiocarcinoma from an Italian perspective

“The main reported outcomes are reported in Table 1. Ivosidenib obtained 7962 € per month OS-gained. FOLFOX obtained 7676 € per month OS-gained.” (opens the source at this quote in a new tab)
“Furthermore, let us consider that this price is based on ex-factory costs and that the real, confidential, is based on further discounts (indicative reduction of a further 40%) [15]. It means that ivosidenib could obtained 3185 € per month OS-gained with the normally applied discounts [15] and with a 38 220 € annual perspective, that is well below the cut-off [14].” (opens the source at this quote in a new tab)
“Another limit is related to the consideration of only the costs of drugs (which account for about 55% of total medical expenses).” (opens the source at this quote in a new tab)

Budget impact model of tovecimig: approach and framework

No evidence found.

Model structures used in economic evaluations of advanced biliary tract cancer

“The progression-free health state was further divided into on-treatment and off-treatment substates. The EAG agreed that the structure of the economic model was appropriate and consistent with previous NICE evaluations for biliary tract cancer.” (opens the source at this quote in a new tab)

“In comparing medical costs and clinical outcomes between patients with BTC treated with pembrolizumab plus chemotherapy and those treated with chemotherapy, we used a partitioned survival model” (opens the source at this quote in a new tab)
“The health states included in this model were PFS, progressed disease (PD), and death.” (opens the source at this quote in a new tab)

“The model included three health states: PFS, progressive disease (PD) and death.” (opens the source at this quote in a new tab)

Budget impact model of tovecimig: perspective and time frame

No evidence found.

Perspectives and time horizons used in economic evaluations of advanced biliary tract cancer

“Most cost-effectiveness studies adopted a healthcare-payer or healthcare-system perspective, while only a minority explicitly incorporated broader societal costs such as productivity loss.” (opens the source at this quote in a new tab)

“Hence, with reference to the dosing cycle of the TOPAZ-1 clinical trial, we set the cycle of the Markov model to 21 days and the time horizon of 10 years to simulate the entire life course of the patient” (opens the source at this quote in a new tab)
“This research was based on the perspective of Chinese and US payers, applying discount rates of 3% and 5% to costs and utilities, respectively” (opens the source at this quote in a new tab)

“This analysis adopted the health care perspectives of third-party payers in China and the US, respectively.” (opens the source at this quote in a new tab)
“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%” (opens the source at this quote in a new tab)

Budget impact model of tovecimig: eligible population inputs

No evidence found.

Company estimate of the United States population eligible for tovecimig

“Over 15K patients/yr potentially eligible for” (opens the source at this quote in a new tab)
“>26,500 1,2 patients diagnosed with BTC (growing to ~34K by 2037) >24,000 patients Receive 1L treatment (10% resection and 5% cure) >17,000 patients Receive 2L treatment (70% of1L patients)” (opens the source at this quote in a new tab)
“>15,000 patients Eligible for” (opens the source at this quote in a new tab)
“High Volume BTC Accounts BTC Accounts with 50+ Patients” (opens the source at this quote in a new tab)

“BTC is estimated to affect approximately 26,500 patients annually in the United States.” (opens the source at this quote in a new tab)

Market-research estimate of incident biliary tract cancer cases in the United States and the seven major markets

“In 2024, the total number of BTC incident cases across the 7MM was approximately 65,000, and this burden is projected to increase over the forecast period.” (opens the source at this quote in a new tab)
“The US accounted for approximately 19K biliary tract cancer cases in 2024, which are further expected to increase by 2034.” (opens the source at this quote in a new tab)

Share of patients with advanced biliary tract cancer who reach second-line therapy in United States claims data

“Of 413 patients, 84.5% received gemcitabine-based first-line (1L) treatment, 46% received second-line treatment, and 16.5% received third-line (3L) treatment.” (opens the source at this quote in a new tab)

“A total of 514 patients (39.6%) died during the follow-up period without receiving a second-line therapy.” (opens the source at this quote in a new tab)

Share of the second-line population without an actionable mutation addressed by an approved targeted therapy

“The only FDA approved therapies for second line treatment of BTC are targeted therapies that address specific tumor mutations or solid tumors that are microsatellite instability high.” (opens the source at this quote in a new tab)
“We believe that the combination of all targeted therapies are appropriately 10-15% of patients with BTC.” (opens the source at this quote in a new tab)

“For the vast majority of patients with BTC whose tumors do not harbor an actionable mutation with an approved targeted therapy, there is currently no FDA-approved treatment in the second line setting.” (opens the source at this quote in a new tab)

“Biomarker - targeted therapies (e.g. FGFR, IDH1, HER2) offer limited benefit and only applicable to 15 - 20% of patients” (opens the source at this quote in a new tab)

Eligible population sizing for a biomarker-selected second-line comparator in England

“HER2 alterations are identified in about 5% to 10% of cholangiocarcinomas and up to 20% of gallbladder cancers.” (opens the source at this quote in a new tab)
“The committee also noted that the eligible population for zanidatamab was small.” (opens the source at this quote in a new tab)

Budget impact model of tovecimig: cost assumptions

No evidence found.

United States drug cost inputs per treatment cycle for regimens used in advanced biliary tract cancer

“Drug costs in the US, $/per cycle” (opens the source at this quote in a new tab)

Drug	Baseline cost in the United States, USD per cycle
Gemcitabine	“15.06”
Cisplatin	“8.72”
Durvalumab	“11,730”
Oxaliplatin	“26.76”
Calcium folinate	“52.48”
Fluorouracil	“18.57”
Irinotecan	“35.88”
Capecitabine	“180.6”
Regorafenib	“21,546”

Ex-factory drug acquisition cost inputs for second-line regimens in cholangiocarcinoma from an Italian perspective

“The costs of drugs are ex-factory, obtained from Italian Medicine Agency (AIFA) public determinations and are expressed in euros (€). The dosage of drugs was considered according to those reported in the phase III RCTs.” (opens the source at this quote in a new tab)
“We have assumed the following costs (value added tax excluded): ivosidenib (blister of 30 tables) = 13 800 € [5], 5-fluorouracil (5-FU) = 3.81 € (1 g/20 mL, 1 vial) [6], folinic acid (FA) = 33.13 € (1 vial = 100 mg) [7], oxaliplatin = 136.74 € (5 mg/mL concentrate for solution for infusion, 1 glass vial of 10 mL) [8].” (opens the source at this quote in a new tab)

Real-world United States cost per patient per month by line of therapy in advanced biliary tract cancer

“The mean PPPM costs for the overall population were $18,274 for all-cause costs, of which approximately 84% ($15,296) comprised BTC-related costs. The total mean (SD) PPPM all-cause costs by LOT were $19,589 ($22,603) for 1LOT, $22,617 ($19,302) for 2LOT and $33,534 ($40,588) for 3LOT.” (opens the source at this quote in a new tab)
“We found that total all-cause PPPM cost was $19,589 during 1LOT, increasing to $22,617 and $33,534 as the treatment advanced to 2LOT and 3LOT, respectively, with >80% of PPPM costs only related to BTC.” (opens the source at this quote in a new tab)

Real-world United States cost per patient per month after failure of first-line therapy for advanced cholangiocarcinoma

“Total mean per patient per month CCA-related healthcare costs were $7,743, with medical services ($6,685) a larger driver of monthly costs relative to treatment costs ($1,058).” (opens the source at this quote in a new tab)
“The total mean all-cause PPPM healthcare costs were $14,403.” (opens the source at this quote in a new tab)

Real-world United States cost per patient per month among patients treated with pemigatinib

“CUP was associated with significantly higher prevalence of metastatic disease (100.0% vs 63.6%), per patient per month (PPPM) ambulatory HCRU (8.2 vs 5.5), and ambulatory costs ($8584 vs $5308).” (opens the source at this quote in a new tab)
“Medical costs averaged $13 444 vs $9881 PPPM for CUP and non-CUP, respectively” (opens the source at this quote in a new tab)

Modelled lifetime treatment costs per patient in advanced biliary tract cancer from a United States payer perspective

“In China and the US, the cost of pembrolizumab plus chemotherapy was higher than that of chemotherapy alone ($85,480 versus $21,616, $297,282 versus $156,281).” (opens the source at this quote in a new tab)

Administration and monitoring cost assumptions for FOLFOX, the principal second-line comparator

“the committee concluded that the model should include a relative dose intensity of 78% for FOLFOX, and that relative dose intensity should be applied to both treatment acquisition and administration costs.” (opens the source at this quote in a new tab)
“At the second meeting, the company updated its model to include the NHS cost collection reference cost for all ECGs. This was £118. The EAG noted that this may be an overestimate and instead chose to use the cost for directly accessed diagnostic services only (£54).” (opens the source at this quote in a new tab)

Companion diagnostic or biomarker testing cost for tovecimig

No evidence found.

Biomarker testing cost assumptions for biomarker-selected second-line comparators

“The clinical experts described that the cancer is screened for different genetic alterations at diagnosis to determine eligibility for targeted second-line treatment.” (opens the source at this quote in a new tab)
“The costs of additional IHC tests were included as part of the company submission.” (opens the source at this quote in a new tab)

“To the present costs we should add the cost of the IDH1 analysis (about 190 € for each patient [18]), that should be performed for all cholangiocarcinoma, with IDH1 mutation in approximately 20% of patients with intrahepatic cholangiocarcinoma [1]” (opens the source at this quote in a new tab)

United States cost of liposomal irinotecan with fluorouracil and leucovorin in second-line biliary tract cancer

No evidence found.

Budget impact model of tovecimig: model outcomes

No evidence found.

Outcomes reported by economic evaluations in advanced biliary tract cancer

“For cost-effectiveness and cost–utility studies, we extracted ICERs, QALYs, life-years, total and incremental costs, willingness-to-pay thresholds, and the probability of cost-effectiveness where available.” (opens the source at this quote in a new tab)
“For cost-of-illness and resource-use studies, we extracted mean or median costs, cost categories, healthcare utilization, hospitalizations, treatment-line costs, productivity outcomes where reported, and principal cost drivers.” (opens the source at this quote in a new tab)

“Costs, life years, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), incremental net health benefits (INHB), and incremental net monetary benefits (INMB) were measured and compared.” (opens the source at this quote in a new tab)

Budget impact model of tovecimig: base-case results

No evidence found.

Base-case results of United States cost-effectiveness analyses in advanced biliary tract cancer

“ICER was US $381,864/QALY from the US payer perspective and US $367,609/QALY from the Chinese payer perspective.” (opens the source at this quote in a new tab)
“PPPM all-cause costs increased across treatment lines: 1L US $19,589, 2L US $22,617, and 3L US $33,534” (opens the source at this quote in a new tab)
“Mean cost per patient-month was US $7743 (medical services US $6685; drug costs US $1058); median OS was 5.3 months” (opens the source at this quote in a new tab)

“In the US, this treatment was not cost-effective, resulting in an improvement in effectiveness of 0.144 QALYs and an increase in overall cost of $141,000 (ICER of $976,925).” (opens the source at this quote in a new tab)

Budget impact model of tovecimig: scenario analyses

No evidence found.

Sensitivity and scenario analyses in economic evaluations of advanced biliary tract cancer

“Sensitivity analysis showed that the analysis was most sensitive to the price of durvalumab.” (opens the source at this quote in a new tab)

“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.” (opens the source at this quote in a new tab)
“The results of the subgroup analysis indicate that better survival properties subgroups were more likely to be cost-effective, although pembrolizumab plus chemotherapy may not be cost-effective for all subgroups.” (opens the source at this quote in a new tab)

“PSA showed price cuts (~50–60%) needed” (opens the source at this quote in a new tab)
“A price reduction of at least approximately 50% improved cost-effectiveness results.” (opens the source at this quote in a new tab)
“In the economic models, the cost of the immune-checkpoint inhibitor component was repeatedly identified as a major driver of unfavorable cost-effectiveness results.” (opens the source at this quote in a new tab)

Summary

No budget impact model of tovecimig has been published and no price has been announced, so the budgetary effect of adding tovecimig to paclitaxel in second-line advanced biliary tract cancer cannot be estimated from public evidence. Because the trial comparator is generic paclitaxel, given identically in both arms, the incremental cost of the regimen is essentially the price of tovecimig. Modelled United States average sales price for paclitaxel was $0.115 per milligram with an intravenous administration cost of $140.16 for the first hour, and the modelled per-cycle United States costs of the FOLFOX components were $26.76 for oxaliplatin, $52.48 for calcium folinate and $18.57 for fluorouracil, against $11,730 per cycle for durvalumab and a reported average monthly United States price of $44,000 for futibatinib. Any price for tovecimig would therefore be additive to a low-cost chemotherapy backbone.

The population inputs a payer would need are partly available. Compass Therapeutics states that more than 26,500 patients are diagnosed with biliary tract cancer in the United States each year, that more than 24,000 receive first-line treatment, that more than 17,000 receive second-line treatment, and that more than 15,000 are potentially eligible for tovecimig because approximately 85% have no actionable mutation; it puts the addressable United States market in second-line biliary tract cancer at more than $3 billion and expects a Biologics License Application submission in the fourth quarter of 2026 with potential approval and launch in 2027. Market research reported approximately 19,000 incident United States cases in 2024 out of approximately 65,000 across the seven major markets, and placed tovecimig third by expected revenue among biliary tract cancer therapies in the seven major markets by 2034. United States claims data give lower second-line rates than the company funnel: 46% of 413 patients with advanced biliary tract cancer initiated second-line therapy in one cohort, and in a second cohort 514 of 1,298 patients (39.6%) died without receiving second-line therapy.

Real-world all-cause costs in advanced biliary tract cancer were $22,617 per patient per month during second-line therapy, up from $19,589 during first-line therapy, of which more than 80% was disease-related, so the existing second-line cost base is substantial before any new agent is added. Published analyses in this indication consistently found that the price of the added biologic was the dominant driver of the incremental cost-effectiveness ratio, with durvalumab at $381,864.39 per quality-adjusted life-year and pembrolizumab at $976,925 per quality-adjusted life-year from a United States payer perspective, both above the $150,000 per quality-adjusted life-year threshold applied, and price reductions of roughly 50% or more were required for targeted agents to approach cost-effectiveness in the jurisdictions studied. Tovecimig requires no companion diagnostic, so a budget impact model would not need the biomarker testing costs that were included for zanidatamab, for which immunohistochemistry testing costs formed part of the submission to the National Institute for Health and Care Excellence.