Abstract
Background: For many patients with advanced lung adenocarcinoma, the diagnosis, staging, and identification of possible genomic mutations or translocations currently represent a challenging process that can delay the identification of the most appropriate treatment pathway. Actual pathways often differ from the "ideal" approach defined by diagnostic and therapeutic pathways (PDT). This is due to the high number of requests for certain diagnostic and staging techniques, particularly PET and EBUS bronchoscopies, the varying organization of hospital facilities, and the need to work collaboratively with different specialties and professionals. Materials and Methods: The article presents the work carried out by the CREMS research group in the first quarter of 2024. Using a mixed methodology, a detailed process analysis was conducted, including workflow mapping and measurement of diagnostic procedure times as a quantitative investigation. In parallel, an economic evaluation of the direct and indirect costs of each phase of the process was conducted. The qualitative methodology adopted involved understanding the Italian operating context through semi-structured interviews with five oncologists working in public hospitals. Finally, a sensitivity analysis was applied to ensure the robustness of the results and to understand which cost items most impact the output. Results: The analysis presented an economic evaluation of the "ideal" pathway for the access, diagnosis, and staging phases. The results showed a 23% cost variance between the minimum cost (€3,497.30) and maximum cost (€4,395.57), still limited compared to the overall resource absorption of the complete pathway, which also includes treatments with tyrosine kinase inhibitors, which are selected based on the patient's tumor molecular profile. Among the main organizational solutions identified were the creation of a single outpatient clinic managed by pulmonologists with the support of oncologists, and the implementation of a single department integrating the activities of the oncology and hematology SSCCs with some of the Services SC's activities. Conclusions: The analysis conducted by the CREMS research team highlighted that, in Italy, diagnostic and therapeutic pathways for patients with advanced lung adenocarcinoma present significant variability and organizational challenges that can delay the identification of the most appropriate treatment. The economic results show limited but significant cost variability, indicating the need to further optimize resources. The proposed organizational solutions, such as the creation of a single outpatient clinic managed by pulmonologists in collaboration with oncologists and the implementation of a single department integrating oncology and hematology, represent promising strategies for improving the efficiency of the diagnostic and therapeutic pathway and reducing waiting times, while also ensuring better coordination between the different specialties involved. These structural changes could lead to significant improvements in patient management, reducing diagnostic delays and optimizing the use of hospital resources.