Standard-of-Care Treatment of Glioblastoma

Objectives: The optimal radiotherapy (RT) duration for older adults with glioblastoma (GBM)—6 weeks (60 Gy/30 fractions) versus 3 weeks (40 Gy/15 fractions)—remains debated. Level 1 evidence demonstrates no significant difference in survival between these regimens. Limited data exist on how insurance coverage influences patient out-of-pocket (OOP) costs across treatment lengths. This study quantifies OOP expenses by insurance plan to improve cost transparency and inform decision-making. Methods: Using NCCN guidelines, standard treatment protocols were defined, including surgical resection, adjuvant RT, and concurrent and adjuvant temozolomide for 12 cycles. A 2-year cost model was constructed for a Medicare- and/or Medicaid-eligible patient aged 65 years or older with GBM. Aggregate OOP costs were calculated by summing deductibles, copayments, and coinsurance under Medicaid, Original Medicare, Medigap Plan G, and Medicare Part D. Results: Treatment charges included neurosurgery, neuro-oncology, and radiation oncology consultations; follow-up; diagnostic imaging; RT planning and delivery; systemic therapy; laboratory monitoring; and tumor-treating fields. Under Original Medicare, beneficiaries pay 20% of Medicare Part B charges after the deductible, with no annual OOP cap, and prescription drug costs under Part D. OOP costs were higher for 30-fraction RT compared with 15-fraction RT. Medigap Plan G beneficiaries incurred OOP costs of $2332.04 and $2319.42 for 30- and 15-fraction RT, respectively. Medicaid fully covered all approved services. Conclusions: Three-week RT for GBM reduces patient OOP costs by ∼5% compared with 6-week RT. Incorporating financial considerations into treatment discussions may help reduce the economic burden of GBM care and support shared decision-making.