The Scottish Medicines Consortium has approved the use of Pfizer's Xiapex on the National Health Service for patients with Dupuytren’s contracture, marking a u-turn from an earlier decision to reject the drug.

Xiapex (collagenase clostridium histolyticum) is the first medicine available for Dupuytren’s contracture, which was previously only treatable with surgery, and so its endorsement is good news for patients who are eligible to receive it.

Dupuytren’s contracture is a progressive condition that affects the connective tissue beneath the skin in the palm. As the disease progresses, collagen deposits form a cord that stretches from the palm to the base of the finger, causing them to contract.

The disease affects around two million people in the UK, and can affect a person’s ability to carry out everyday tasks such as driving, washing or shaking hands.

The SMC has recommended Xiapex as an option for adult patients with Dupuytren’s contracture of moderate severity, who have a palpable cord and up to two affected joints per hand and are suitable for limited fasciectomy (removal of part of the cord), but for who percutaneous needle fasciotomy (dividing the cord without excision) is not considered an option.

Application resubmitted

This endorsement for restricted NHS use follows a resubmission by Pfizer in January this year, after the SMC concluded that the use of Xiapex within its licensed indication and up to two affected joints per hand as a substitute for established surgical interventions would not be a cost effective use of resources.

In its submission, Pfizer estimated that treatment with its drug would cost £1,723 and fasciectomy would cost £2,560, resulting in savings of £837 per patient, although the agency notes that weaknesses in the comparison mean the cost-minimisation analysis is uncertain.

Still, the economic case was considered demonstrated for the new target patient population proposed in the submission, the SMC said.