Tovecimig (CTX-009)

No price has been announced for tovecimig and no budget impact model, cost-effectiveness analysis, or health technology assessment of the product was identified, so its budgetary effect cannot be estimated from public evidence. Because the comparator in COMPANION-002 is generic paclitaxel given identically in both arms, the incremental cost of the regimen is essentially the price of tovecimig, additive to a low-cost chemotherapy backbone. Modelled United States costs for the displaced or accompanying therapies were an average sales price of $0.115 per milligram for paclitaxel with an intravenous administration cost of $140.16 for the first hour, and per-cycle costs of $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.

Population inputs are partly available but inconsistent between sources. Compass Therapeutics states that more than 26,500 people 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 places the addressable United States market in second-line biliary tract cancer at more than $3 billion. Market research reported approximately 19,000 incident United States cases in 2024 out of approximately 65,000 across the seven major markets. United States claims data give lower second-line rates than the company funnel: 46% of 413 participants with advanced biliary tract cancer initiated second-line therapy in one cohort, and 514 of 1,298 participants (39.6%) died without receiving second-line therapy in another. Real-world all-cause costs were $22,617 per patient per month during second-line therapy, of which more than 80% was disease-related, so a substantial cost base exists before any new agent is added.

Published economic analyses in this indication consistently found the price of the added biologic to be the dominant driver of the incremental cost-effectiveness ratio. Durvalumab added to gemcitabine and cisplatin was estimated 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. A 2026 systematic review of 20 economic studies in biliary tract cancer identified no cost-effectiveness analysis of second-line FOLFOX. The National Institute for Health and Care Excellence recommended zanidatamab in second-line biliary tract cancer in May 2026 with an acceptable incremental cost-effectiveness ratio at the upper end of £25,000 to £35,000 per quality-adjusted life-year and a confidential price. Tovecimig requires no companion diagnostic, so a budget impact model would not need the biomarker testing costs included in that submission. No analyst peak-sales forecast for tovecimig could be sourced from a document that states it.

Compass Therapeutics reported $180 million in cash at 30 June 2026 with a runway into 2028, and licensed the product from ABL Bio for $5 million upfront and a $6 million milestone, with up to $96 million in development and regulatory milestones and $303 million in commercial milestones plus tiered single-digit royalties in oncology; Handok holds South Korean rights and Elpiscience holds Chinese rights.