4CPS-277 Real-world survival and cost analysis of antifibrotic therapy in idiopathic pulmonary fibrosis: a multicentre retrospective study

<h3>Background and Importance</h3> Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal interstitial lung disease with a median survival of 2–5 years from symptom onset. Antifibrotic agents–nintedanib and pirfenidone–slow disease progression and may extend survival. However, real-world data on survival outcomes and treatment costs remain limited. <h3>Aim and Objectives</h3> To compare overall survival (OS) in patients with IPF treated with nintedanib versus pirfenidone, and to assess associated treatment costs. <h3>Material and Methods</h3> A retrospective observational study was conducted across six public hospitals, including patients aged ≥18 years diagnosed with IPF and receiving antifibrotic therapy (nintedanib or pirfenidone) between January 2016 and December 2024. Collected variables, obtained from the national electronic prescription system, included sex, age, treatment, treatment line, and dispensing records. Overall survival (OS) was assessed from treatment initiation using Kaplan–Meier analysis and the log-rank test. To reduce cross-over bias, only patients treated with a single antifibrotic were included in the comparative analysis. Statistical analysis was performed using R software, version 4.5.1. The economic analysis comprised: (1) Theoretical annual treatment cost (ATC) per patient based on NHS list prices (2018–2024), reflecting price evolution and the impact of generic launches (2) Real-world mean annual cost per patient, calculated from dispensing records and treatment duration. Costs were compared before (2016–2022) and after (2023–2024) generic pirfenidone entry. <h3>Results</h3> A total of 244 patients were included; 102 died, and 142 (58.2%) were censored at study end. Adjusted mean OS from treatment start was 4 years 8 months. Among 207 monotherapy patients, 82 (39.6%) died–52.4% on pirfenidone and 31.2% on nintedanib. Median OS was 6 years 9 months for nintedanib and 3 years 8 months for pirfenidone (HR = 1.33; 95% CI 0.85–2.07; p = 0.097). Pirfenidone patients were older (70.5 vs 66.4 years; p = 0.0003). Given the association between advanced age and mortality, this imbalance may partly explain the numerical survival difference. From 2018 to 2024, theoretical annual costs fell from €17,222.9 to €744.8 (pirfenidone) and €17,196.1 to €10,638.7 (nintedanib). Mean real-world annual cost declined 48.2% post-generic <h3>Conclusion and Relevance</h3> Although not statistically significant, a survival trend favouring nintedanib was observed. Generic pirfenidone substantially reduced treatment costs, supporting its value in reducing the economic burden of IPF <h3>Conflict of Interest</h3> No conflict of interest