• Chulhan Kim, Sung-Youn Chun, Sun Jung Kim, Ki Hwa Yang, Ji Hyeon Baek, Ji Hyeon Shin, Ji Won Yoo, Young Woo Chang, Keon Wook Kang, and Jinwook Hwang.
• Department of Nuclear Medicine, Chungbuk National University Hospital, Cheongju, Korea.
• J. Korean Med. Sci. 2022 May 16; 37 (19): e153.

BackgroundF-18 Fluorodeoxyglucose positron emission tomography (F-18 FDG PET), which can cover the body from the skull base to the thigh in one scan, is beneficial for evaluating distant metastasis. F-18 FDG PET has interested policymakers because of its relatively high cost. This study investigated the effect of the F-18 FDG PET reimbursement criteria amendment on healthcare behavior in breast cancer using an interrupted time series (ITS) analysis.MethodsWe retrospectively analyzed the inpatient and outpatient data from Korea's Health Insurance Review and Assessment Service (HIRA) from January 1, 2013 to December 31, 2018. ITS analysis was performed for the number of each medical imaging modality and the total medical imaging cost of the breast cancer patients.ResultsThe annual number of breast cancer patients has been increasing steadily since 2013. The trend of F-18 FDG PET increased before the reimbursement criteria was amended, but intensely decreased immediately thereafter. The chest and abdomen computed tomography scans showed a statistically significant increase immediately after the amendment and kept steadily increasing. A change in the total medical imaging cost for the breast cancer patient claimed every month showed an increasing trend before the amendment (β = 5,475, standard error [SE] = 1,992, P = 0.008) and rapid change immediately after (β = -103,317, SE = 16,152, P < 0.001). However, there was no significant change in the total medical imaging cost at the long-term follow-up (β = -912, SE = 1,981, P = 0.647).ConclusionRestriction of health insurance coverage for cancer may affect healthcare behaviors. To compensate for it, the policymakers must consider this and anticipate the impact following implementation.© 2022 The Korean Academy of Medical Sciences.

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