OBJECTIVES::  To perform a treatment cost comparison of pirfenidone versus nintedanib on the treatment of idiopathic pulmonary fibrosis (IPF) under the Brazilian private healthcare system perspective. METHODS::  Both treatment's ex-factory prices were obtained from official published lists, by the Brazilian Ministry of Health, considering the incidence of taxes (ICMS 18%). Annual treatment cost was calculated based on the dosage of pirfenidone (2.403 mg/day) and nintedanib (150 mg BID) obtained from their respective Brazilian labels. A year was assumed to be 12 months with 30 days each. Results were shown for 2 scenarios: first year (including initial dose ramp up for pirfenidone) and maintenance phases. RESULTS::  Pirfenidone and nintedanib unitary costs were BRL 9,144 (BRL 33.87 per 267 mg tablet) and BRL 14,916 (BRL 248.60 per 150 mg tablet), respectively, according to their list prices. Pirfenidone showed an annual treatment cost of BRL 107,591 and BRL 109,724 on the first year and subsequent years of treatment, respectively. Nintedanib incurred an annual cost of BRL 178,988 independent of year of treatment. Those results led to savings of approximately BRL 70,000 per year per patient treated with pirfenidone compared to those treated with nintedanib (a relative reduction of approximately 40%). Pirfenidone’s dose ramp up, on the first year of treatment, did not decrease significantly the treatment cost, implying on a reduction of just 2% when compared to subsequent years. CONCLUSIONS:: Pirfenidone was lower than the cost of nintedanib.