Financial Toxicity in High-Grade Glioma Resection: A Retrospective Analysis

Background: Despite its association with lower survival rates among patients in various disease states, financial toxicity is often overlooked in health care. The aims of our study are to elucidate the effect of financial toxicity on the care of glioma patients.

Methods: We retrospectively evaluated clinical information of 130 patients with newly diagnosed glioblastoma from a single institution between 2014 and 2021. The Area Deprivation Index characterized patients' socioeconomic status. Insurance claims were analyzed to assess the financial burden on patients following their neurosurgical procedure. This burden was then compared with socioeconomic factors using adjusted multivariable regression models.

Results: A total of 55 (42%) patients had out-of-pocket (OOP) costs with 24 (18%) unable to pay off their procedure. High socioeconomic disadvantage (3.01; P=0.02); other race (0.166; P=0.039); and public insurance (0.114; P<0.0001) were significantly associated with an increased risk of accumulating OOP costs. Age (0.097; P=0.026); African American race (29.87; P=0.029); marriage status (0.114; P=0.017); and high socioeconomic disadvantage (5.96; P=0.031) were significantly associated with risk of payments being sent to collections. Those with private insurance accrued higher gross OOP costs (1093 vs. 506, [P < 0.001]). Those with public insurance had a lower hazard of death (0.397; P=0.003).

Conclusions: Our results suggest there is a strong association between financial toxicity, socioeconomic status, and the standard of care following GBM resection. They also shed light on the financial toxicities associated with the care of these patients.