FormalPara Key Points for Decision Makers

This study highlights the significant clinical and economic strain of stage IV non-small cell lung cancer (NSCLC) in Mexico's public and private healthcare systems.

This study also highlights significant advancements in molecular profiling rates in public hospitals, while also supporting the urgent need for standardized testing practices across institutions to ensure consistent and effective treatment approaches for NSCLC patients.

The study underscores the need for more standardized and equitable healthcare practices across sectors to ensure that all patients benefit from advancements in NSCLC treatment.

1 Introduction

In recent years, lung cancer has prevailed as the leading cause of death among cancer patients globally [1], with developed countries experiencing higher rates correlating with the prevalence of smoking habits [2, 3]. In Mexico, lung cancer is the fourth leading cause of death among neoplasms despite the decreasing smoking rates in men and women. Each year, the country registers 7588 new cases of lung cancer, with up to 82% of cases diagnosed at a metastatic stage [4,5,6].

Lung cancers are categorized into two types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), with the latter being the most prevalent form, accounting for 80% of cases [7]. NSCLC is notably heterogeneous, presenting various histological subtypes. However, this heterogeneity does not extend to the prevalence of the stages at diagnosis. It is estimated that there are currently around 7000 patients with NSCLC in Mexico, approximately 60% of whom are diagnosed at an advanced or metastatic stage [7,8,9,10,11,12].

The treatment options and clinical outcomes for NSCLC vary significantly according to the disease stage, making accurate and timely diagnosis and staging critical. Recent decades have seen advancement in next-generation sequencing (NGS), enhancing the management of NSCLC through the detection of genetic alterations and facilitating the development of targeted therapies [13,14,15,16]. Currently, various targeted treatments are available for different genetic alterations such as EGFR, ALK, KRAS, ROS1, BRAF, RET, MET, HER2, and NTRK [17].

Delayed diagnosis not only significantly impacts patient survival rates but also increases the cost of cancer treatment and reduces the patient productivity index [18,19,20,21]. Therefore, the study of the clinical management of patients with metastatic NSCLC in Mexico is of vital importance for evaluating and improving the conditions of the healthcare system.

Currently, there are no descriptive studies focused on the evaluation of the clinical, social, and economic burden of patients with metastatic NSCLC in Mexico. Although some recent publications have described the clinical status of lung cancer types in the country, or their economic impact on hospital costs and disability pensions, none have thoroughly examined the economic burden of stage IV NSCLC and its social repercussions [11, 22].

Research conducted in various countries has highlighted the significant impact of cancer stage at diagnosis, and the quality of life of patients, on various aspects, including treatment costs, hospital resource utilization, caregiver productivity, absenteeism, and overall productivity loss. The observed relationship between these factors and cancer progression offers a critical basis for assessing the healthcare systems’ effectiveness in managing NSCLC [20, 21, 23]

The current study aimed to estimate the clinical, economic, and social burden caused by stage IV NSCLC in both private and public healthcare centers in Mexico, based on real-world evidence extracted from these centers.

2 Methodology

2.1 Data Collection and Patient Selection Criteria

Data were gathered from four hospital centers in Mexico City: Centro Médico Nacional Siglo XXI (IMSS), Centro Médico Nacional “20 de Noviembre” (ISSSTE), Mexican Institute of Respiratory Diseases (INER), and Medical Center ABC. The first three centers represent the public health system in Mexico, while the latter is a private sector entity. It is worth mentioning that during the study period, all centers were converted into specialized care centers for coronavirus disease 2019 (COVID-19), refocusing activities to respond to the pandemic. As a result, data may be incomplete in some instances. All patient data were anonymized before analysis. The research protocols were authorized by the Ethics and Research Committees of each center.

The study population included patients diagnosed with metastatic NSCLC (stage IV), older than 18 years of age, and treated with antitumor cancer treatments during the years 2019 and 2020. Inclusion criteria were all patients with a diagnosis of NSCLC who received antitumor treatment between 2019 and 2020 and had documented follow-up from diagnosis in 2019 to 31 December 2020. All patients with NSCLC as a secondary diagnosis, with undefined clinical stage, who received treatment before being treated during the study periods at the centers under study, or received concomitant treatment with another unit were excluded. Data collection fields per center are outlined in Appendix 1.

2.2 Clinical Burden

The clinical variables collected in each center depended on their availability and were used to identify the epidemiological data (age, sex, smoking status), clinical staging of the tumor, cancer type, Eastern Cooperative Oncology group (ECOG) at diagnosis, molecular profiles, diagnosis and follow-up consultations, clinical progression, pharmacological and non-pharmacological interventions, laboratory and imaging studies, and the adverse events of medications and complications related to NSCLC.

For the specific evaluation of tumor progression, time to progression (TTP) was used for progression, defined as months of progression-free survival since diagnosis or treatment change and death of the patient. This method was chosen since the observation period and the number of registered deaths did not allow the correct use of a Kaplan–Meier progression-free survival model to evaluate the correlation between the treatments and their effects on the mortality rate to estimate the associated accumulated probability of survival.

2.3 Social Burden

To determine the social burden derived from the clinical management of NSCLC, three variables were analyzed: absenteeism, presenteeism, and loss of productivity of the caregiver. Absenteeism and presenteeism were calculated for working-age patients, while the loss of productivity of the caregiver is described for the entire population. The productivity loss of caregivers in the current context, as previously studied in the literature using the multiplier method, is attributed to the spillover effect, where unpaid or informal caregivers choose to dedicate their time and effort to provide care [24]. This results in a utility loss due to the demands of caring for patients with more complex needs, thereby adding an additional dimension to the impact of NSCLC on patients and their surroundings.

Absenteeism in working-age patients (<65 years) was evaluated by the number of missed workdays due to diagnosis and follow-up consultations (1 day per consultation), chemotherapy application and recovery (3 days per cycle), laboratory and imaging tests (1 day per consultation), and hospitalizations and recovery (15 days post-hospitalization). This only applied to patients with an ECOG status of 0 or 1, as patients with an ECOG score >1 were considered to be absent all year. For the estimation of working-age presenteeism, the productivity loss associated with NSCLC reported in the literature (21%) was multiplied by the proportion of working-age patients with an ECOG score of 1 who progress [24].

The caregiver’s productivity loss was calculated for the whole population. The estimated productivity loss from caregivers associated with NSCLC reported in the literature was 11% [24], which was then multiplied by the proportion of patients with an ECOG score >1, and ECOG 0 and 1 patients who presented progression.

2.4 Economic Burden

The economic burden estimation was divided into clinical and social components. It is worth mentioning that all monetary values reported are adjusted to the inflation rate reported by the Instituto Nacional de Estadistica y Geografía (INEGI) and with the present value, in 2022 MXN [25].

For the clinical component, only hospital costs of complications, adverse events, consultations, hospitalizations, treatments, and tests were considered.

In the context of Mexico’s healthcare system, the economic burden associated with stage IV NSCLC can be borne by a combination of entities, including the government, public, and private insurance systems, as well as out-of-pocket expenses by patients. The public healthcare system, financed by the government and social security contributions, covers a significant portion of the population, providing treatments and services at subsidized rates or at no direct cost to the patient. However, in the private healthcare sector, costs are typically covered by private insurance or directly by patients, often leading to higher out-of-pocket expenses.

For the monetization of complications and adverse events, the costs for their treatment in public institutions were obtained from the latest report on Diagnostic-Related Groups (DRGs) 2017 published by the IMSS [26], while costs for treatment in the private sector were taken directly from the current market value, taking into consideration the oncological treatment pathways. For economic estimation of the cost of follow-up consultations and hospitalizations, the latest update of the ‘Costos Unitarios por Nivel de Atención Médica’ in the ‘Diario Oficial de la Federación’ was used for the public sector [27]. Hospital rates at the private Medical Center ABC were provided by the institution as well as current market rates [28, 29]

The costs of pharmacological treatments in the public sector were provided directly by the “20 de Noviembre” Medical Center, while those for the private sector were obtained from the current market value [30].

To estimate the cost of diagnosis and follow-up tests, their prices in public hospitals were obtained from the basic tables of the instrumental and medical equipment catalog of the National Health Sector [31]. The national costs of genetic tests were also used. The prices of diagnostic tests and follow-ups from the private sector were provided by the Medical Center ABC and its current private market value [28]. A table has been included in the appendix to summarize the sources of all economic variables.

The general economic estimation of the clinical variables is described in Eq. 1. This was used for the cost per complication, adverse events management, follow-up consultations, pharmacological treatment, diagnosis and follow-up testing, and hospitalization variables.

$$CpCV= \frac{{P}_{CV}\cdot {X}_{CV}\cdot {C}_{CV}}{TP}$$
(1)

Equation 1 Cost per clinical variable; average cost per patient for each of the clinical variables, where TP = total number of patients applicable to the variable, PCV = number of patients per clinical variable, XCV = average use of the clinical variable, and CCV = clinical variable cost.

For the economic estimation of the social burden, the average salary of the affiliated workers to the Mexican Institute of Social Security (IMSS in Spanish) was used for the public sector [32]. The daily salary of the private healthcare sector users was defined by the average utilization of private insurance services (14.44%), thus being represented by the daily average salaries of the upper two deciles of the population [33, 34]. These units, defined as average daily income (ADI), were used to calculate all the social variables, as stated in Eqs. 2–4.

$$Absenteeism={D}_{a}\text{ * ADI}$$
(2)

Equation 2 Absenteeism. Monetization of the number of days per year that working-age patients must be absent from work, where Da = days of patient absenteeism annually.

$$Presenteeism={D}_{t}\text{ *}{ PP}_{patient}\text{* ADI}$$
(3)

Equation 3 Presenteeism. Loss of annual productivity associated with the clinical condition when working-age patients are present at work, where Dt = days worked by the patient annually, and PPpatient = percentage loss of productivity of the patient.

$$LCP={D}_{tc}\text{ *}{ PP}_{caregiver}\text{*ADI}$$
(4)

Equation 4 Loss of caregiver productivity. Loss of annual productivity associated with patient care due to their clinical condition, where Dtc = days worked annually by the caregiver, and PPcaregiver = percentage loss of productivity of the caregiver.

2.5 Statistical Analysis

Comparative analyses were conducted using Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) to examine the differences in economic burden between private and public healthcare institutions. Average costs for each category of clinical and financial burden were calculated across the institutions. Given the variability of sample sizes and data distribution across the centers, Welch’s t-test was employed to compare the means.

Mean and standard deviations were computed for both private and public institutions. Welch’s t-tests were then conducted to assess the statistical significance of the differences in means between ABC and each public institution. The degrees of freedom for each test were calculated using the Welch–Satterthwaite equation, which provides an adjustment based on the sample sizes and variances of the groups being compared. The results of these tests provided insight into the significance of the differences observed, enabling a comprehensive evaluation of the burden of NSCLC across both settings.

3 Results

A total of 188 patients were included in the analysis. The patient cohort had a mean age of 64 years, with a smoking prevalence of 47% during the study period. The main cancer histology was adenocarcinoma (81%), followed by squamous cell carcinoma cells (15%) and large cell carcinoma (2%). Molecular testing was performed in 80% of patients.

Patient demographics and cancer types, broken down by public and private healthcare sectors, are detailed in Table 1. Molecular testing revealed estimated glomerular filtration rate (EGFR) mutations in 26% of patients, programmed death-ligand 1 (PD-L1) expression in 20%, and ALK rearrangements in 6%. Complications were common, observed in 73% of patients, with dyspnea (48%), chest pain (30%), and pleural effusion (12%) being the most frequently reported. Treatment approaches varied, combining pharmacological treatments with or without palliative care and non-pharmacological interventions.

Table 1 Epidemiology of the analyzed population of stage IV non-small cell lung cancer
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The treatment landscape, as outlined in Table 2, shows a broad utilization of pharmacological interventions (49%), either as standalone therapies or in combination with palliative care (11%), non-pharmacological treatments (13%), or both (5%).

Table 2 Clinical treatment of stage IV non-small cell lung cancer
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Patient treatment regimens and treatment-related adverse events are also presented in Table 2. These data were available for the National Medical Center “20 de Noviembre”, National Medical Center Siglo XXI, and Medical Center ABC. In 12% of the recovered records, there was no documentation of the type of antitumor cancer treatments, despite this being an inclusion criterion for the study. Upon inquiry, the medical centers indicated that these patients were registered as receiving treatment during the specified period, but the data were either not retrieved or lost. This issue was observed at both the INER and IMSS hospitals. All their patients presented at least one adverse event as a result of pharmacological treatments, with the most common being fatigue (65%).

Figure 1 illustrates the time to progression (TTP) among patients receiving first-line pharmacological treatments across each center and the collective sample. The figure highlights the varying TTP across different treatment modalities, including chemotherapy, targeted therapy, and their combinations. Notably, the figure demonstrates differences in progression-free rates among these treatment approaches, with certain therapies showing a tendency to extend progression-free intervals more effectively.

Fig. 1
figure 1

Descriptive curves of time to first progression for the a INER1; b Medical Center “20 de Noviembre”; c IMSS; d Medical Center ABC; and e total sample. Black line indicates total, orang line indicates chemotherapy, green line indicates targeted therapy, blue line indicates immunotherapy; orang dotted lineindicates chemotherapy and target therapy; blue dotted line indicates chemotherapy and immunotherapy, and pink dotted line indicates chemotherapy, target therapy, and immunotherapy. 1Some clinical data were not available due to center reconversion to a specialized care unit for COVID-19, thus the values reported here do not reflect the actual standard of care of the center. Unavailable data are reported as NR. INER Instituto Nacional de Enfermedades Respiratorias, IMSS Instituto Mexicano del Seguro Social, ABC American British Cowdray Medical Center, COVID-19 coronavirus disease 2019, NR not reported

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The clinical tools used by the hospitals for the diagnosis and follow-up of NSCLC are presented in Table 3. These data were provided by the Medical Center “20 de Noviembre”, National Medical Center Siglo XXI, and Medical Center ABC. Consultations were made for all patients in the three centers, with an average of 8.78 appointments per patient over the study period (2019–2020).

Table 3 Diagnosis and clinical follow-up of patients with non-small cell lung cancer
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The social burden associated with the care of NSCLC is detailed in Table 4. This table describes the impact on absenteeism and presenteeism among working-age patients within the study sample, who constituted 40% of the total. The table outlines the number of days lost due to various factors, including consultations, laboratory testing, pharmacological therapy applications, and hospitalizations. The total social burden for working-age individuals comprises both absenteeism and presenteeism.

Table 4 Social burden of patients with non-small cell lung cancer
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Additionally, another aspect of the social burden relates to the productivity loss experienced by caregivers at the centers. This loss is documented for all patients across the four centers.

Table 5 compares the total economic impact of NSCLC across different healthcare settings, revealing notable differences in clinical and social burdens between the public and private sectors. Although this varies between centers, an increased effect can be seen from the private sector, as higher costs and targeted treatments are favored to be used. Similarly, the burden increases in working-age patients due to their working days and productivity loss.

Table 5 Total average economic impact of the clinical and social burden of non-small cell lung cancer per working-age patient
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The differences between institutions were analyzed. Table 6 presents the statistical analysis for each institution, detailing the comparison of means between the public and private centers. All comparisons of means yielded p-values <0.0001, indicating statistical significance.

Table 6 Statistical analysis and comparison
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4 Discussion

This study includes a sample of 188 patients from Mexico City. National statistics suggest there are approximately 4200 stage IV NSCLC patients across Mexico. Given that Mexico City represents about 14% of the national population, this equates to an estimated 600 cases, making our sample nearly one-third of the expected cases in the area [7,8,9,10,11,12]. This proportion underscores the strength and representativeness of our study within the regional context. Additionally, our findings corroborate the trend of an increasing incidence of NSCLC among women; in our cohort, 60% of patients were female, which is a notable increase compared with the 40% reported in earlier studies [4,5,6]. Consistent with previous research, the average age of patients in our study was >50 years, further affirming the comparability of our sample to existing literature [38].

The prevalence of adenocarcinoma doubles the prevalence previously reported in the literature; however, it is similar to recent studies in Latin America where adenocarcinoma is the main type at a prevalence of 64%, followed by squamous cell carcinoma (24%) [39]. In this study cohort, the most commonly tested markers were EGFR, BRAF, ROS1, PD-L1, ALK, and KRAS. Notably, molecular profiling rates in public hospitals showed a remarkable increase, with the INER at 82%, the Institute for Social Security and Services for State Workers (ISSSTE) at 80%, and the Mexican Social Security Institute (IMSS) at 76%. These figures markedly exceed previously reported rates for ISSSTE (40%) and IMSS (0%) [40], indicating a significant advancement in the application of molecular diagnostics in public healthcare.

This upward trend in molecular profiling rates is a positive indication of the growing emphasis on precision medicine in the treatment of advanced NSCLC, allowing for more targeted and effective therapies. However, the heterogeneity in testing practices across different institutions highlights an urgent need for standardization to ensure consistent and accurate treatment approaches, essential for improving patient outcomes and advancing NSCLC research.

The most common alteration in the sample was EGFR, with 26% of the population presenting with EGFR, followed by PD-L1 (20%) and ALK (6%). BRAF and KRAS mutations were found in only one and two patients, respectively. Nevertheless, the relevance of these rates must be taken within the context of the study. As molecular testing is selective in most centers, the cohort was not tested homogeneously for all reported markers. Therefore, alteration rates may differ from those reported previously in the literature [41, 42].

The majority (73%) of patients presented at least one medical complication during the treatment of NSCLC, with dyspnea being the most common (48%), followed by chest pain (30%) and pleural effusion (12%). This high incidence of complications highlights the severe impact of advanced NSCLC on patient well-being. The prevalence of these is similar to that reported in the National Consensus for the Diagnosis and Treatment of NSCLC [43], where it is stated that between 15 and 65% of patients may present with dyspnea. It is worth mentioning that the incidence rate of superior vena cava syndrome (2%) is lower than the 20% reported in 2013 [43]. Other complications such as seizures, pneumonia, pericardial effusion, fatigue, neurological impairment, hypercalcemia, and blood clots were only present in 1–2% of patients.

The main difference observed between public and private institutions is that all patients at Medical Center ABC received pharmacological treatments coupled with other types of interventions. Nevertheless, the significance of this result is hampered by two factors: the total amount of patients overseen by the institution during the study period and the availability of resources, as the hospital was also reconverted to a specialized care unit for COVID-19, affecting the care of patients with NSCLC. Studies on the impact of the pandemic on the care of lung cancer reported a drop of 35% in new cancer diagnoses during the year 2020, along with a 42.9% decrease in ambulatory care in COVID-19-specialized hospitals, which may explain the low patient volumes in the centers in this study [44] Similarly, a low number of non-pharmacological treatments, such as surgeries, was reported during this period [45], which is in accordance with the rate found in this study. However, the number of patients who received treatment (88%) was higher than those in other countries, such as Canada, during this period (83%) [45].

The distribution of pharmacological treatments varies between treatment lines; 28% and 5% of patients received either a second or third line of treatment, being more common in the private center (50% and 27% for the second and third lines, respectively). Chemotherapy remains the most used type of regimen, with 53%, 59%, and 40% utilization on each of the lines of treatment. The most used chemotherapies were paclitaxel + carboplatin, pemetrexed, and gemcitabine on the first, second, and third line of treatment, respectively. While public centers tend to prefer the use of monotherapy as the primary first-line regimen, Medical Center ABC treats 72% of its patients with a combined treatment of chemotherapy and immunotherapy. This heterogeneity is repeated on the rest of the lines of treatment. However, contrary to a 2019 study that stated that the ISSSTE had no access to immunotherapy treatments [46], 5% of patients had access to these treatments in their first line of treatment, 43% in the second line, and 100% in the third line. Therefore, the present work shows advances of the Mexican public health system to include innovative treatments in their care of stage IV NSCLC.

These therapies provide not only a clinical effect but also an economic and social effect. When NSCLC does not progress, patients have a lower risk of hospitalization [47], present fewer adverse events [48], have greater productivity derived from their clinical improvement, and have a longer life expectancy [47, 48]. Thus, the use and implementation of targeted therapies generates value not only on a clinical dimension but also on the economic and social aspects of patients, ministries of health, family members, employers, and other parties interested in patient improvement [48].

4.1 Clinical Burden

The IMSS, ISSSTE, and Medical Center ABC offer palliative care for their patients; however, all patients only receive this kind of treatment at the private institution, with an average of six consultations. The hospitalization tendencies between all centers also differ; Medical Center “20 de Noviembre” reports that only 60% of their patients are hospitalized, while the National Medical Center Siglo XXI presents a higher hospitalization rate (83%). In contrast, all Medical Center ABC’s patients were hospitalized, with a reduced average time of 4.72 days.

The TTP analysis is limited by the small sample size at the Medical Center ABC (Fig. 1c) and the low use of combined therapies (14% of patients receiving first-line pharmacological treatment). This results in TTP curves for combined treatments showing larger drops in progression-free rates due to the reduced population using them. Additionally, as illustrated in Fig. 1e, therapies that include targeted therapy appear to delay progression the most. However, it is important to note that this preliminary analysis is limited, as the focus of the study was not to analyze the effectiveness of the treatments but rather to assess the burden of the current management of NSCLC on the medical centers.

A difference can be observed in laboratory testing between the institutions as the private sector uses these tools on all its patients for diagnosis and clinical follow-up. The use of imaging techniques does not differ significantly between centers or treatment stages, with the most common being chest computed tomography for diagnosis and positron emission tomography scan for follow-up appointments.

4.2 Social Burden

The data in Table 4 highlights the considerable time commitments demanded from patients, illustrating the significant impact of NSCLC treatment on their daily activities and professional responsibilities. Previous studies have shown that patients with deteriorating functionality (ECOG >1) significantly impact caregiver productivity, which is why this criterion was chosen for our study along with caregiver productivity loss [21]. The varying results observed between centers in our study are related to the ECOG status at diagnosis, reflecting the differing levels of disease severity at which patients present to the respective institutions [49].

4.3 Economic Burden

The analysis of the economic and social implications of NSCLC treatment in Mexico reveals significant disparities between the public and private healthcare sectors. As Tables 5 and 6 illustrate, the clinical burden cost in the private sector is notably higher, being double that of the maximum burden observed in the public sector. This disparity stems from elevated expenses in pharmacological treatments, mutational profiling, laboratory testing, imaging, and hospitalization in the private sector in concordance with previous studies [50]. Notably, the costs of treatments are comparable in both sectors, but the access costs of laboratory tests, imaging and hospitalization vary significantly, leading to this discrepancy.

In the context of social burden, a parallel trend has been observed. The private sector incurs double the maximum social burden compared with the most burdened public healthcare center. This variation is age-dependent, reflecting the productivity loss in non-working-age patients. The calculation of this loss is influenced by the average salary, which is considered higher in the private sector due to our methodological approach. Therefore, the economic valuation of productivity loss differs between sectors.

It is worth mentioning that INER has a lower total economic burden compared with other public hospitals in this study, due to two factors: (1) its lack of reported variables due to its conversion to a COVID-19-specialized hospital; and (2) its focus on chemotherapy as the main treatment regimen for its patients.

4.4 Limitations

This study, while comprehensive, is subject to certain limitations and potential biases inherent in its design and the context of its execution. Primarily, the observational nature of the study and the specific period during which it was conducted, i.e. the COVID-19 pandemic, present unique challenges. Additionally, the current study is representative of the urban population (79%) in the country [25]; however, it may not accurately reflect the management of NSCLC in rural areas.

Selection Process and Bias Avoidance: It is crucial to note that there was no selection preference or randomization in the patient recruitment process. All patient profiles included in the study met our predefined selection criteria without bias. This approach ensured a representative sample of the NSCLC patient population within the constraints of our study design.

Data Completeness during COVID-19: To mitigate bias arising from the observational period coinciding with the COVID-19 pandemic, only patients with complete traceability were included. This decision excluded any partial or incomplete records, further strengthening the study’s integrity; however, this stringent criterion might have limited the breadth of data, particularly from institutions such as the INER, which, during the study period, had repurposed its resources for COVID-19 care. Consequently, the economic estimation of NSCLC’s impact on these institutions may not fully encapsulate the utilization of medical tools, equipment, and facilities.

Representation of the Private Sector: The representation of patients from the private sector (Centro Medico ABC) is relatively low compared with the public sector. This disparity reflects the broader healthcare utilization patterns in Mexico, where the majority of the population relies on public healthcare services. The limited number of patient profiles from the private sector that met our study criteria is indicative of this trend and was not a result of selective bias. Expanding the patient pool from the private sector would have necessitated compromising the study criteria, potentially introducing bias for the sake of a larger sample size.

5 Conclusion

This study has illuminated several critical aspects of the treatment, economic, and social burden of stage IV NSCLC in Mexico, highlighting notable advancements and persistent challenges. The increasing rates of molecular profiling in public hospitals such as the INER, ISSSTE, and IMSS mark a significant step forward in the adoption of precision medicine for NSCLC. However, the disparity in molecular testing practices between institutions underscores an urgent need for standardization to ensure uniform and effective treatment approaches across different healthcare settings.

The study also reveals the diverse impacts of NSCLC management across clinical, social, and economic dimensions. The integration of innovative treatments, such as immunotherapy and targeted therapies, in public healthcare institutions reflects progress in the Mexican health system’s approach to NSCLC care. In particular, the study’s findings on the economic burden demonstrate considerable cost disparities between the public and private sectors, driven by differences in treatment expenses, diagnostic testing, and hospitalization.

In conclusion, this study provides a nuanced understanding of the current landscape of NSCLC treatment in Mexico within the context of a challenging period marked by the COVID-19 pandemic. It highlights the progress made in molecular diagnostics and treatment options, while also drawing attention to the need for more standardized practices and equitable healthcare across sectors.