OBJECTIVES: The aim of this study was to estimate the budget impact of nintedanib compared to current scenario, treatment with pirfenidone and best supportive care, for patients with idiopathic pulmonary fibrosis (IPF) in the Greek healthcare system. METHODS: Our analysis estimated the budget impact of adopting nintedanib in the Greek healthcare system from a third-party payer's perspective (EOPYY) for a 5-year time horizon (2016-2020). Model assumptions and market uptake of treatments were validated by a Greek key opinion leader. The clinical evidence was derived from three phase III randomized clinical trials (INPULSIS I and II for nintedanib, CAPACITY for pirfenidone). Parametric model extrapolation was used for mortality and time to acute exacerbations. Indirect treatment comparison was conducted on mortality and acute exacerbations, due to lack of direct clinical data. The analysis considered costs for drug acquisition, acute exacerbations and management of adverse events. Unit costs were derived from publicly available sources in Greece (2015). RESULTS: Our analysis showed that adopting nintedanib led to a reduction of acute exacerbation events (2016: -5 events; 2020: -18 events, cumulative) and costs of exacerbation events (2016: €4,154; 2020: €15,385, cumulative) compared to current scenario. The incremental budget impact of introducing nintedanib in the Greek healthcare system is low (2016: €2,088,281) with an estimated percentage impact on the total pharmaceutical expenditure ranging from 0.10% in 2016 to 0.20% in 2020, cumulative, in a 5-year time period. CONCLUSIONS: Our results suggest that introduction of nintedanib may lead to cost savings due to the events of acute exacerbation avoided. Given that IPF is a rare disease and taking into consideration the unmet medical need for IPF patients, adopting nintedanib may generate cost savings and have a relatively low budget impact on the Greek healthcare system.