A combination of N-acetylcysteine (NAC) and pirfenidone may be the most cost-effective option for the treatment of idiopathic pulmonary fibrosis (IPF), according to a study published in eClinicalMedicine.

To evaluate the cost-effectiveness of available IPF therapies, the authors searched 8 databases for eligible randomized controlled trials published in any language between January 1, 1992, and February 1, 2023.

They found 51 publications investigating the efficacy or tolerability of different IPF therapeutic options through indicators such as all-cause mortality, acute exacerbation rate, disease progression rate, or adverse events. There were no restrictions regarding drug dose, treatment duration, or length of follow-up.

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Next, the researchers performed Bayesian network meta-analysis (NMA) within random-effects models and a cost-effectiveness analysis using the NMA data by developing a Markov model from a US payer’s perspective.

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According to data from 12,551 patients with IPF, pirfenidone and NAC plus pirfenidone appear to be the most effective and well-tolerated therapeutic options.

The pharmacoeconomic analysis suggested that the NAC plus pirfenidone combination had the highest probability of cost-effectiveness (ranging from 53% to 92%) at willingness-to-pay thresholds of US$150,000 and $200,000, on the basis of mortality, disability-adjusted life years, and quality-adjusted life years.

In comparison with placebo, NAC plus pirfenidone therapy improved efficacy by increasing quality-adjusted life years by 7.02 as well as reducing disability-adjusted life years by 7.10 and deaths by 8.40, while increasing the overall costs by $516,894. NAC appears to be the minimum-cost drug.

“Given that clinical practice guidelines have not addressed the application of this therapy, large, well-designed and multicentre trials are warranted to provide a better picture of IPF management,” Zhao and colleagues emphasized.

A diagnosis of IPF carries a high economic burden for individuals and healthcare resources, yet the costs associated with the efficiency of IPF medications remain insufficiently explored.  


Zhao C, Yin Y, Zhu C, et al. Drug therapies for treatment of idiopathic pulmonary fibrosis: a systematic review, Bayesian network meta-analysis, and cost-effectiveness analysis. EclinicalMedicine. Published online June 29, 2023. doi:10.1016/j.eclinm.2023.102071