Delgocitinib Coverage Could Save Health Plans $88M Over 3 Years

Covering delgocitinib cream for adults with moderate to severe chronic hand eczema (CHE) who have failed topical corticosteroids (TCS) could save a hypothetical 1-million-member commercial health plan more than $87 million over 3 years, according to a budget impact analysis published in the Journal of Medical Economics.¹ The savings stem almost entirely from lower drug costs compared with the off-label treatments currently used in this population.

Moderate to severe CHE not only has a negative impact on patients’ quality of life but is also associated with economic burdens, the authors explained

The High Cost of Off-Label AD Therapies in CHE

Delgocitinib cream (Anzupgo; LEO Pharma), a topical pan-Janus kinase inhibitor (JAKi), received FDA approval in July 2025 as the first and only therapy specifically indicated for moderate to severe CHE in adults for whom TCS are inadequate or inadvisable.² Because no other CHE-specific treatment existed before that approval, clinicians have long relied on biologics and oral JAK inhibitors indicated for atopic dermatitis (AD), such as dupilumab, abrocitinib, upadacitinib, and topical ruxolitinib, to manage the disease off-label. That off-label reliance comes at a steep price: eczema-related costs for patients on monoclonal antibodies or oral JAK inhibitors can reach more than $21,000 per patient per year.³

The new budget impact model, utilizing IQVIA real-world prescribing data, compared 2 scenarios over a 3-year horizon: one in which delgocitinib was not covered by the hypothetical health plan, and one in which it was. The eligible population of patients with moderate to severe CHE who were refractory to steroids was estimated at roughly 10,500 in Year 1, growing slightly to about 11,700 by Year 3, based on a CHE prevalence of 9.6% drawn from the Chronic Hand Eczema Epidemiology, Care, and Knowledge of real-life burden in the United States study.

Quantifying the 3-Year Cumulative Plan Savings

The projected savings were modest in the first year, at approximately $3 million, but grew sharply as delgocitinib's assumed market share expanded from 1.1% in Year 1 to 20.4% by Year 3. Net savings reached $21.4 million by Year 2 and $63.4 million by Year 3, for a 3-year cumulative total of $87.75 million.¹

Cost savings were driven primarily by drug costs, which accounted for 97.2% of total savings. Reductions in adverse event (AE) management and monitoring costs contributed the remainder. On a per-patient basis, the model projected a cumulative savings of $636 per patient per month (PPPM) and $7631 per patient over the 3-year period. Treatment costs in the delgocitinib-covered scenario fell from $3262 PPPM in Year 1 to $2607 PPPM by Year 3, while costs in the scenario without coverage remained near $3000 throughout.

The researchers also noted that the savings from reduced AE costs and monitoring suggest that delgocitinib's adoption could ease the broader treatment burden on patients.

Model Limitations and the Need for Real-World Evidence

The model carried several limitations that the authors acknowledged. Because CHE-specific prescribing guidelines do not yet exist, the analysis used AD dosing protocols as a proxy for off-label treatments, which may not fully reflect real-world prescribing. The model also did not account for flare severity, treatment adherence, comorbidities, or individual genetic factors, all of which could shift actual cost outcomes. Since the model focused exclusively on steroid-refractory patients, it excluded those for whom TCS are simply contraindicated, potentially understating the eligible population and the full budget impact.

Real-world evidence on delgocitinib utilization patterns remains limited, and the treatment utilization assumptions were drawn from the phase 3 DELTA 3 extension trial rather than observed US market data. As prescribing expands post-approval, updated analyses grounded in claims data will be needed to validate or refine these projections.

For now, the analysis offers payers an early economic framework for a drug that, as The American Journal of Managed Care^® has previously covered, is redefining how clinicians think about CHE—not just as a symptom cluster to be managed with whatever is on hand, but as a distinct condition with a dedicated, approved therapy for the first time.²

References

1. Singh-Landa J, Bin Sawad A, Bappoo Y, et al. Budget impact analysis of delgocitinib for moderate to severe chronic hand eczema in the United States. J Med Econ. 2026;29(1):1555-1564. doi:10.1080/13696998.2026.2675851
2. Shaw ML. FDA approves delgocitinib for moderate to severe hand eczema. AJMC^®. July 24, 2025. https://www.ajmc.com/view/fda-approves-delgocitinib-for-moderate-to-severe-hand-eczema
3. Joszt L. Chronic hand eczema linked to high costs, corticosteroid overuse. AJMC. May 20, 2026. Accessed June 5, 2026. https://www.ajmc.com/view/chronic-hand-eczema-linked-to-high-costs-corticosteroid-overuse