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Draft guidance consultation

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1 Recommendations

1.1

Delgocitinib should not be used to treat moderate to severe chronic hand eczema in adults when topical corticosteroids have not worked or are not suitable.

1.2

This recommendation is not intended to affect treatment with delgocitinib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.

What this means in practice

Delgocitinib is not required to be funded in the NHS in England to treat moderate to severe chronic hand eczema in adults when topical corticosteroids have not worked or are not suitable. It should not be used routinely in the NHS in England.

This is because the available evidence does not suggest that delgocitinib is value for money in this population.

Why the committee made these recommendations

Usual treatment for moderate to severe chronic hand eczema when topical corticosteroids have not worked or are not suitable includes phototherapy (ultraviolet light therapy) or alitretinoin.

Clinical trial evidence shows that delgocitinib is more effective at improving symptoms of chronic hand eczema than alitretinoin or 'vehicle cream' (a cream that does not contain an active ingredient).

Delgocitinib has not been directly compared in a clinical trial with phototherapy, but an indirect comparison suggests that delgocitinib is more effective.

There are uncertainties in the economic model. These include the method used to handle missing trial data and the estimates used for how long people continue treatment.

The cost-effectiveness estimates for delgocitinib compared with phototherapy are within the range that NICE considers an acceptable use of NHS resources. But when compared with alitretinoin, they are above this range. It is not possible to clearly define who would be offered one treatment over the other, so delgocitinib cannot be recommended when alitretinoin would be unsuitable. So, delgocitinib should not be used.