Acute exacerbations of interstitial lung disease are hard on patients — and costly too

Acute exacerbations of fibrosing interstitial lung disease (ILD) are associated with substantially greater health care utilization and costs compared with periods without exacerbations, according to new research by Boehringer Ingelheim Pharmaceuticals.

The study, led by Joseph Yang, Pharm.D., M.S., an associate director of HEOR value demonstration for Boehringer Ingelheim, was published in the Journal of Managed Care & Specialty Pharmacy in February 2026. Yang and his colleagues and looked at the economic and health care burden associated with acute exacerbations in patients with fibrosing ILD, a group of progressive lung diseases characterized by scarring of lung tissue and declining respiratory function.

Acute exacerbations in fibrosing ILD are typically defined as sudden episodes of worsening respiratory symptoms accompanied by new radiographic abnormalities and rapid decline in lung function. These events often require urgent medical evaluation and hospitalization and are associated with a high risk of mortality, particularly in conditions such as idiopathic pulmonary fibrosis. They are known to worsen outcomes and increase mortality risk, but not much is known about the full impact of these events on healthcare systems and payer costs.

Yang and colleagues wanted to address that gap. They conducted a retrospective analysis of a large administrative claims database to evaluate health care resource utilization and direct medical costs associated with acute exacerbations among patients with fibrosing ILD. The analysis identified 8,929 patients as having at least one qualifying acute exacerbation event. They compared those patients with matched patients who did not have exacerbations, allowing them to estimate the incremental health care burden associated with these episodes.

The study found that patients who experienced acute exacerbations had substantially higher levels of health care utilization compared with matched controls without exacerbations. The data showed that inpatient utilization was 53% higher among patients with exacerbations, while outpatient utilization was 13% higher. Differences were even more pronounced for ILD-related care, with 98% higher inpatient utilization and 63% higher outpatient utilization in the exacerbation cohort. These increases in care use translated into significantly higher per-patient-per-month medical costs, with hospitalizations representing the largest driver of overall spending.

Hospitalizations accounted for the majority of the increased health care burden, reflecting the severe nature of acute exacerbations and the need for intensive management during these episodes. After all, patients experiencing exacerbations often require advanced respiratory support, diagnostic testing and prolonged inpatient care.

Based on the data, the researchers found that overall, health care costs were significantly higher among patients with acute exacerbations compared with those who did not experience such events. The findings highlight how exacerbations represent key drivers of economic burden in fibrosing ILD, adding substantial costs to already complex disease management.

The study’s results, the authors noted, reflect the importance of strategies aimed at preventing or delaying acute exacerbations in this patient population. By reducing the frequency or severity of these events, clinicians and health systems may be able to improve patient outcomes while also reducing health care costs.

The authors noted that real-world evidence plays an important role in understanding the economic impact of chronic respiratory diseases. While clinical trials often focus on clinical outcomes such as lung function or survival, analyses using health care claims data can provide insight into how diseases affect health care utilization and costs in routine clinical practice.

What’s more, understanding the drivers of medical costs in fibrosing ILD may also help inform payer decision-making and policy development. Treatments that reduce exacerbations or slow disease progression could potentially generate downstream cost savings by reducing hospitalizations and other resource-intensive care.

Yang and his colleagues discussed the limitations of their study. Administrative databases, they noted,often lack detailed clinical information, including disease severity, pulmonary function test results or imaging findings that could influence outcomes. Additionally, coding-based definitions of acute exacerbations may not capture all clinical events.

Still, the study provides important insight into the healthcare burden associated with fibrosing ILD exacerbations in real-world practice. The findings suggest that preventing acute exacerbations could represent a key target for improving patient outcomes while also reducing the substantial health care costs associated with these serious respiratory events.