Objective: The objective of this study was to monitor and evaluate prescription patterns for interstitial lung diseases (ILDs) at a tertiary care center in North India, specifically aiming to assess adherence to NICE guidelines, examine the impact of these practices on patients' quality of life and therapeutic adherence, and conduct a pharmaco-economic analysis to determine the cost-effectiveness of the treatments provided.Methodology: This 12-month prospective study at King George’s Medical University involved 85 ILD patients. Prescription patterns were monitored with a CRF and NICE guidelines. Adherence was categorized as low, medium, or high. Quality of life was measured using the K-BILD questionnaire (0–100). Pharmacoeconomic analysis evaluated the cost and effectiveness of therapeutic regimens. The data was analyzed with SPSS version 23.0.Results: The study of 84 participants highlights a diverse demographic with a prevalence of hypersensitivity pneumonia and a significant association between smoking and idiopathic pulmonary fibrosis. Methylxanthines and oral corticosteroids are the most commonly prescribed medications, while nintedanib is favored in disease-modifying treatments. Significant cost variations are observed in both single-drug and fixed-dose combinations, impacting treatment affordability. The study also notes declining quality of life, low medication adherence, and a focus on supportive care with minimal use of invasive procedures.Conclusion: This study highlights hypersensitivity pneumonitis and a preference for methylxanthines and oral corticosteroids. It reveals significant cost variations in drug prescriptions, with some four-drug combinations proving more cost-effective despite higher costs. The findings stress the need for a balanced approach to cost and efficacy, improved medication adherence, and strategies to manage cost variability, aligning with previous research on ILD treatment.