A Czech national administrative real-world study of diagnostics and treatment pathways of non-small-cell lung cancer stratified by disease stage: From data to actionable indicators

ABSTRACT Introduction Building on our previously published methodology for claims-based pathway mapping, we extended the analysis by incorporating disease staging. The aim of this study was to develop and evaluate quality indicators (QIs) in patients with non-small cell lung cancer (NSCLC). Methods This retrospective, longitudinal cohort study spanned 2017–2023, with follow-up data extending to September 2025. Data were obtained from the National Cancer Registry (NCR), the National Registry of Reimbursed Health Services (NRRHS), which is organized through seven health insurance funds providing nationwide coverage. The index date was defined as the date of the first biopsy (BX) followed by a histopathological examination (HP), along with the ICD-10 code C34. Incident patients aged ≥18 years were included if no prior malignancy was reported, and the presence of PET/CT or CT examination was mandatory in the final verified cohort. The presence of multidisciplinary team (MDT) discussion, time to treatment, availability of care in a Complex Oncology Center (COC), and completeness of predictive biomarker testing were considered key QIs. Results We analyzed the care pathways of 15,886 patients with NSCLC; 3,380 (21.3%) were not treated, and 1,837 (11.6%) were excluded due to the absence of (PET) CT prior to biopsy (BX). The final verified cohort included 10,669 patients with a median age of 69 years (interquartile range, 64–74). The incident stage distribution comprised of stage I/II (27.6%), stage III/IV (67.9%), and 4.5% unknown. Multidisciplinary team (MDT) review was reported in 53.9% of patients, with a median time to MDT discussion of 37 days. Surgery (SX) was performed in 81.0% of stage I and 68.4% of stage II patients. Fewer than 50% of patients initiated treatment within 8 weeks, regardless of disease stage. Centralization of care in COCs and implementation of MDT review showed a positive temporal trend, although disparities across disease stages and regions persisted. PD-L1 testing was documented in 70.0% of stage IV and 65.2% of stage III patients. Conclusions Administrative claims data linked with the NCR enabled stage-stratified monitoring of NSCLC care pathways and the identification of actionable QIs, which were implemented as a national tool for continuous quality evaluation of cancer care in the Czech Republic. KEY MESSAGES What is already known on this topic Patient pathway monitoring and quality indicators (QIs) for lung cancer care — including timeliness of treatment, multidisciplinary team discussion (MDT), and centralization in specialized centers (COCs) — have been established in several European countries. Population-level data integrating administrative claims with cancer registry staging data to evaluate QIs across disease stages remain limited. What this study adds Stage-stratified analysis of 10,669 NSCLC patients revealed that fewer than 50% initiated treatment within 8 weeks, with a declining trend over time despite improvements in MDT utilization and care centralization in COCs. PD-L1 testing rates in stages III–IV increased over 2021–2023 but showed substantial regional variability, highlighting opportunities for improving equity of access to biomarker-guided therapy. How this study might affect research, practice or policy The methodology has been implemented as a national tool for continuous quality evaluation of cancer care in the Czech Republic, with PD-L1 testing completeness proposed as an additional OI alongside MDT discussion, time to treatment, and COC centralization.