Delgocitinib Cream Projected to Save US Health Plans Millions for Chronic Hand Eczema

Chronic hand eczema affects nearly 1 in 10 US adults, yet until last year, clinicians had no treatment approved specifically for it—only drugs borrowed off-label from atopic dermatitis. That gap may now come with a financial upside as well as a clinical one.

Why Chronic Hand Eczema Has Relied on Off-Label Treatment

Chronic hand eczema (CHE), which is eczema affecting the hands or wrists that persists longer than 3 months or recurs at least twice annually, carries a self-reported prevalence of 9.6% among US adults, according to the multinational Chronic Hand Eczema Epidemiology, Care, and Knowledge (CHECK-US) study of more than 10,000 participants.¹ Among adults whose moderate to severe disease does not respond to topical corticosteroids (TCS), long the first-line treatment, many have said they would prefer a nonsteroidal alternative, since prolonged steroid use carries risks such as skin atrophy.

Diagnosing hand eczema is often complicated by its many possible causes, according to the American Academy of Dermatology. Occupational exposure to water, detergents, and solvents, along with allergic reactions to materials such as latex gloves, can all trigger or worsen the condition, and identifying the culprit can take considerable trial and error.² That complexity, layered onto the limits of TCS, has left many patients cycling through systemic and topical therapies developed for atopic dermatitis rather than hand eczema itself.

Modeling a Hypothetical Health Plan's Costs

Delgocitinib cream, a topical Janus kinase (JAK) inhibitor, is the only treatment the FDA has approved specifically for CHE. To estimate its financial impact, the researchers built a 3-year budget impact model for a hypothetical US commercial health plan of 1 million members, comparing a scenario without delgocitinib cream coverage to one with it against off-label options already in practice: oral JAK inhibitors abrocitinib and upadacitinib, topical JAK inhibitor ruxolitinib, and biologic dupilumab, with market share drawn from IQVIA data.

The eligible population was built from a published-literature funnel: 9.6% of the 1 million members were assumed to have CHE, 42.7% of whom had moderate to severe disease; 51.2% had received TCS, and half of those were steroid refractory and eligible for advanced therapy, yielding 10,494 patients in year 1, rising to 11,095 in year 2 and 11,696 in year 3. Costs were adjusted to 2024 dollars.

Delgocitinib Cream Tied to Growing Health Plan Savings

Covering delgocitinib cream was projected to cut spending by $2,973,478 in year 1; $21,424,214 in year 2; and $63,355,366 in year 3, for cumulative 3-year savings of $87,753,057. Savings grew alongside delgocitinib cream's projected market share, modeled as rising from 1.1% of eligible patients in year 1 to 20.4% by year 3. Nearly all the savings, 97.2%, came from reduced drug costs, with smaller contributions from lower spending on adverse events (AEs) (1.54%) and monitoring (1.27%).

Per-patient costs fell from $3262 to $2607 per patient per month (PPPM) between years 1 and 3 when delgocitinib cream was covered vs a smaller decline, from $3286 to $3059 PPPM, when it was not. That gap produced cumulative PPPM savings of $636 and per-patient-per-year savings of $7631, widening from $283 in year 1 to $5417 by year 3.

Fewer Safety Trade-Offs Than Other Off-Label Options

Delgocitinib cream, marketed as Anzupgo, was approved by the FDA in 2025 based on the phase 3 DELTA 1 (NCT04871711) and DELTA 2 (NCT04871711) trials, which found a safety and tolerability profile comparable with vehicle alongside improved signs, symptoms, and quality of life. Dosing assumptions drew on the open-label DELTA 3 extension trial (NCT04949841), which treated patients from the parent trials as needed for up to 36 additional weeks.

Unlike several other JAK inhibitors used off-label for CHE, delgocitinib cream carries no boxed warning, a distinction that may factor into both clinical uptake and the AE-related savings observed. “In the context of the high costs associated with moderate to severe CHE, delgocitinib cream represents a potential cost-saving option,” the researchers wrote.

Where the Model's Assumptions Could Fall Short

Because no CHE-specific treatment guidelines exist, the model used on-label atopic dermatitis dosing as a proxy, which may not mirror real-world prescribing. Utilization assumed an average of 3.2 flares per year without capturing flare severity, adherence, comorbidities, or genetic factors, and AE data pulled from trials with differing reporting conventions may have skewed AE-related cost estimates.

The analysis also included only steroid-refractory patients, excluding those for whom TCS would be inadvisable from the outset, which may limit generalizability. Still, phase 3 data showed consistent efficacy and safety regardless of CHE subtype, supporting some generalization beyond the population studied.

For payers, the analysis suggests delgocitinib cream could ultimately cost less than continuing to rely on drugs never approved to treat CHE. Adults with moderate to severe disease, many of whom already cycle through corticosteroids and off-label systemics, could gain an on-label option, alongside potential savings for the payers covering their care.

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. Dry, scaly, and painful hands could be hand eczema. American Academy of Dermatology. Accessed July 27, 2026. https://www.aad.org/public/diseases/eczema/types/hand-eczema