The Impact of the Amendment of the Health Insurance Coverage for F-18 Fluorodeoxyglucose Positron Emission Tomography on the Healthcare Behaviors for Breast Cancer:An Interrupted Time Series Analysis of the Korean National Data From 2013 to 2018
Background@#F-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 healthcarebehavior in breast cancer using an interrupted time series (ITS) analysis. @*Methods@#We retrospectively analyzed the inpatient and outpatient data from Korea’s Health InsuranceReview 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 imagingcost of the breast cancerpatients. @*Results@#The annual number of breast cancerpatients 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 imagingcost for the breast cancerpatient 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 imagingcost at the long-term follow-up (β = −912, SE = 1,981, P = 0.647). @*Conclusion@#Restriction of health insurance coverage for cancer may affecthealthcarebehaviors. To compensate for it, the policymakers must consider this and anticipate the impact following implementation.