Economic Burden of Idiopathic Pulmonary Fibrosis: Updated Evidence on Costs and Resource Use

Idiopathic pulmonary fibrosis is a rare progressive respiratory disease associated with high morbidity, poor survival and substantial healthcare demands. The introduction of antifibrotic therapies in the mid-2010s has reshaped treatment patterns and may have shifted the balance of medical costs. This study aimed to systematically update and expand a 2018 systematic review of the economic burden of idiopathic pulmonary fibrosis, providing an opportunity to assess trends before and after the adoption of antifibrotic drugs.

We updated the 2018 literature review by applying the same systematic protocol and search strategy, extending coverage to August 2025. Searches were conducted in EMBASE, MEDLINE and the Cochrane Library. Eligible studies reported unit costs, total costs or healthcare resource utilisation in adult patients with idiopathic pulmonary fibrosis, regardless of treatment received. Relevant data were extracted across multiple healthcare resource utilisation and cost categories. Total medical costs from US studies were inflated to 2025 US dollars to examine temporal trends. Findings were synthesised narratively.

A total of 85 studies met the inclusion criteria. Sixty-two studies reported healthcare resource utilisation and cost data, and 23 were economic evaluations. Most studies originated from Europe and North America, with two from China and one from South Korea; none was identified from low- or lower-middle-income countries. Annual per-patient costs varied widely, from approximately $1700 in South Korea to over $110,000 in recent US studies. Evidence suggests a shift in cost burden: earlier studies reported hospitalisations as the largest driver of expenditure, whereas more recent analyses identified drug acquisition as the dominant cost, accounting for over 70% of total spending in some settings. US studies that included antifibrotic costs reported total medical costs above $125,000, reaching up to $175,000. In contrast, studies excluding antifibrotic therapies reported total costs below $100,000. The annual probability of all-cause hospitalisation was reported around 23% when antifibrotic drugs were available and 26% in studies without antifibrotic drugs. Economic evaluations were heterogeneous in design, perspective and assumptions. Estimated long-term costs and incremental cost-effectiveness results varied considerably by country, limiting generalisability across healthcare systems.

This review confirms that idiopathic pulmonary fibrosis imposes substantial and rising healthcare costs. Antifibrotic use is associated with a shift in the distribution of costs, with higher drug expenditure and lower reported hospitalisation rates. The global picture remains heterogeneous, with major differences across countries reflecting system structure, pricing and treatment access.