2387 - National Radiotherapy Utilization and Health-System Recovery after COVID-19: A Population-Level Public Insurance Analysis

Purpose/Objective(s): COVID-19 disrupted cancer care globally, yet national evidence on radiotherapy (RT) recovery in middle-income health systems remains limited. We assessed changes in RT utilization during and after the pandemic using a national public insurance claims database covering priority cancer treatments under a guaranteed-access program. We hypothesized that RT volume declined in 2020 and recovered heterogeneously thereafter, potentially requiring adaptive expansion of outsourced treatment capacity.

Materials/Methods: We conducted a retrospective population-based analysis of national claims capturing RT treatments reimbursed by the Chilean public health insurance system, which covers approximately 80% of the national population, through its legally mandated guaranteed cancer coverage program. Each record represented an RT-related treatment claim from 2018–2024. Primary outcome was annual RT utilization (number of RT claims). Secondary outcomes included annual unique patients (encrypted ID), regional distribution by treating region, and delivery modality categorized as publicly delivered versus publicly funded outsourced treatment. Trends were summarized descriptively and periods pre-pandemic (2018–2019), pandemic (2020), and post-pandemic (2021–2024) were compared using Poisson models reporting incidence rate ratios (IRR) with 95% confidence intervals (CI).

Results: RT claims decreased from 6,379 in 2019 to 5,924 in 2020 (-7.1%), with unique patients decreasing from 6,272 to 5,796 (-7.6%). Pandemic-year utilization was lower versus pre-pandemic (IRR 0.95, 95% CI 0.92–0.98; p=0.001). Post-pandemic utilization exceeded baseline levels (IRR 1.19, 95% CI 1.17–1.21), reaching 7,863 RT claims and 7,648 unique patients in 2024 (+23.3% and +21.9% vs 2019), suggesting compensatory system expansion. Regional recovery patterns were heterogeneous. During the recovery phase, the proportion of publicly funded RT delivered through outsourced private providers increased from 22.7% pre-pandemic (2018–2019) to 35.9% in 2022, before returning toward baseline (23.1% in 2024).

Conclusion: In this large national analysis of a public insurance system covering ~80% of the population, RT utilization declined during the pandemic but subsequently rebounded above baseline, accompanied by heterogeneous regional recovery. A temporary expansion of publicly funded outsourced delivery suggests adaptive system-level capacity mechanisms supporting treatment continuity. These findings support the use of national administrative datasets to inform health-system policy and radiotherapy capacity planning following major health disruptions.