Anna Kron

Background Building on the German national Network Genomic Medicine (nNGM), which has improved access to molecular testing for lung cancer patients, the project DigiNet aims to enhance digital networking via a Network Data Platform (NDP) in order to optimize data exchange and personalized therapy management of non-small cell lung cancer (NSCLC). Methods To analyze facilitating and inhibiting factors from the perspective of healthcare providers (HCPs), qualitative interviews with respect to the implementation process were conducted. Qualitative content analysis in accordance with Kuckartz and Rädiker was undertaken, and the Consolidated Framework for Implementation Research (CFIR) was applied to guide the analysis. Results Overall, 40 HCPs contributed to 51 interviews, with 11 taking part twice. Facilitating factors included the establishment of DigiNet upon the preexisting infrastructure of nNGM and the systematic documentation of treatment data, thereby enabling a comprehensive review of the entire clinical pathway. Especially for peripheral locations, one benefit lies in the improved information flow and networking with nNGM centers. The most frequently reported barrier was the double documentation of patient data, as in-house and the NDP were used in parallel. There is a need for digital interfaces to enable transfer into existing software at each individual clinical site. Conclusions DigiNet highlights the potential of intensified digital networks to optimize precision oncology while underscoring the need to address regulatory and interoperability challenges to ensure integration into routine care.

Background: Lung cancer is among the most prevalent and deadly cancers, with around 57,000 new cases annually in Germany. Despite advances in targeted therapies, many patients still lack sufficient access to state-of-the-art comprehensive molecular diagnostics and personalised therapy throughout the disease course. This study identifies gaps in access to personalised lung cancer care in Germany. A primary objective was to analyse how many lung cancer patients are not captured by the established quality and network structures - namely, centres of the national Network Genomic Medicine (nNGM) and the lung cancer centres certified by the German Cancer Society (DKG) - to identify and ultimately close these gaps. Methods: Publicly available data were used from inpatient quality reports, the databases of nNGM and certified lung cancer centres (DKG-LZ), the outpatient specialist medical care programme (ASV) supplemented by incidence data from the German Centre for Cancer Registry Data (2022). Differences among nNGM, DKG-LZ and ASV were assessed, focusing on non-affiliated hospitals as proxies for putative lack of quality-assured molecular diagnostic access. Geographic mapping was used to visualise regional disparities. Results: The analysis included 993 hospitals with a total of 167,216 reimbursed lung cancer cases. 240 hospitals with 98,797 cases (59%) are affiliated with the nNGM. 108 hospitals with 78,591 cases (47%) are certified or cooperate with a DKG-LZ. ASV is provided at 152 hospitals or ASV partner hospitals (71,763 cases, 43%). nNGM and DKG jointly cover 276 hospitals and 114,472 cases (69%). Adding ASV, overall quality-affiliated coverage increases to 124,419 cases (74%). However, 668 hospitals with a total of 42,797 cases (26%) are not affiliated with any of these structures. Geographic analysis revealed regional disparities, notably in Northern Brandenburg, Lower Saxony, and Saxony-Anhalt characterised by high-incidence areas and non-affiliated hospitals managing large volumes of lung cancer cases. Conclusions: Significant disparities in access to quality-assured molecular diagnostics persist. Expanding nNGM and integrating high-volume hospitals could raise coverage to over 85%. Standardising molecular diagnostics and quality requirements across nNGM, DKG, and ASV could further optimise access to high-quality personalised lung cancer care in Germany and build a unified real-world evidence base for equitable, consistent care.

Multidrug-resistant Gram-negative bacteria (MDR-GNB) cause serious infections and aggravate disease progression. Last resort antibiotics are effective against MDR-GNB and are reimbursed by flat rates based on German diagnosis-related groups (G-DRG). From a hospital management perspective, this analysis compared hospital reimbursement for last resort antibiotics with their acquisition costs to outline potential funding gaps. Retrospective analyses based on medical charts and real-life reimbursement data included patients with pneumonia due to MDR-GNB treated in intensive care units (ICU) of a German tertiary care hospital (University Hospital Cologne) between January 2017 and December 2020. Drug-associated hospital reimbursement of G-DRG was compared with drug acquisition costs based on preliminarily approved last resort antibiotics (cefiderocol, ceftazidime-avibactam, ceftolozane-tazobactam, and imipenem-cilastatin-relebactam) according to label. Funding gaps were determined for the treatment of Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, and mixed infections, respectively. Most of the 31 patients were infected with Enterobacterales (n = 15; 48.4%) and P. aeruginosa (n = 13; 41.9%). Drug-associated G-DRG reimbursement varied from 44.50 EUR (mixed infection of P. aeruginosa and Enterobacterales) to 2265.27 EUR (P. aeruginosa; mixed infection of P. aeruginosa and Enterobacterales). Drug acquisition costs ranged from 3284.40 EUR in ceftazidime-avibactam (minimum duration) to 15,827.01 EUR for imipenem-cilastatin-relebactam (maximum duration). Underfunding was found for all MDR-GNB, reaching from 1019.13 EUR (P. aeruginosa; mixed infection of P. aeruginosa and Enterobacterales) to 14,591.24 EUR (Enterobacterales). This analysis revealed the underfunding of last resort antibiotics in German hospital treatment. Insufficient reimbursement implies less research in this field, leading to a more frequent use of inappropriate antibiotics. The cycle closes as this contributes to the development of multi-drug resistant bacteria.