Evidence-based decision making for health policy in HIRA

Tags: Poster
Baek SJ1, Seo JY1, Lee SM1, Bae JW1, Seo KH1, Kim HO2
1Health Insurance Review and Assessment Service, 2College of Medicine, Ewha Womans University


The Health Insurance Review and Assessment Service(HIRA) is the organization in South Korea that is responsible for the benefit claims review, quality assessment, and the setting and management of benefit standards of the National Health Insurance System. Gastric cancer is the most common malignancy in Korea, and fluorodeoxyglucose(FDG)-positron emission tomography(PET) is selective intensive review item in HIRA. There was a demand for evidence-based review of clinical effectiveness due to the controversy of the value of FDG-PET in evaluation of gastric cancer.


To define appropriate use of FDG-PET and to determine claims review guideline of FDG-PET in gastric cancer.


We organized consensus development for claims review(CDCR) committee. The CDCR consists of physicians of internal medicine, general surgery, pediatrics, nuclear medicine, including chair. The CDCR developed a questionnaire about the staging(9 items), RT planning(1 item), re-staging(4 items), measures of treatment efficacy(4 items). The CDCR reviewed evidence and medical standard, i.e., textbook, review article, guidelines, health policies in foreign countries. Also CDCR reviewed characteristics of gastric cancer in Korea. The consensus was achieved with modified RAM.


From April to June 2019, a total of six meetings was held for review evidence and medical standard about key questions. To evidence-based decision making, established decision algorithm. (figure)

Finally, 11 items were agreed. The consensus was developed for review guideline by President of HIRA. The review guideline was announced officially at December 2019.


The review guideline of FDG-PET in gastric cancer is expected to improve review consistency. HIRA will continue to make efforts for the advancement of evidence-based decision making system. Especially, for debate issue, it is one of trials for making transparent health policy decisions.

Patient or healthcare consumer involvement: N/A