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)

Tovecimig (CTX-009)

Modeling overview