Real-World Survival Outcomes of Glioblastoma Patients Under Universal Temozolomide Access in Uruguay: A Retrospective Cohort Study (2009–2018) and Implications for Health Policy

Background Glioblastoma (GB) is the most aggressive primary brain tumor in adults and is traditionally associated with a poor prognosis. In 2009, Uruguay’s National Resource Fund (Fondo Nacional de Recursos [FNR]) began guaranteeing universal public funding for standard temozolomide (TMZ), establishing an accessible standard of care. This study evaluates the long-term real-world survival impact of that policy and discusses its implications for the future integration of high-cost immunotherapies. Methods We conducted a retrospective observational cohort study of adult patients with histologically confirmed supratentorial hemispheric GB who completed initial diagnosis and treatment between January 2009 and December 2017 at the Neuro-Oncology Unit of the Hospital de Clínicas “Dr. Manuel Quintela”, Montevideo, Uruguay. Follow-up extended through December 2018. Overall survival (OS) was estimated using the Kaplan-Meier method, and the study was reported in accordance with the STROBE guidelines. Results A total of 32 patients met the inclusion criteria. Mean age was 50.7 ± 15.3 years (range: 19-75 years), and 62.5% (n = 20) were male. Gross total resection was achieved in 56.3% of cases. Median OS for the entire cohort was 17 months (95% CI: 7.0-26.9). Patients who completed the full adjuvant Stupp regimen achieved a significantly longer median OS than those with incomplete treatment (24 vs. 11 months; log-rank p = 0.023). Conclusions Universal public funding for TMZ in Uruguay has achieved real-world outcomes consistent with international benchmarks. However, the biological ceiling of the Stupp regimen underscores the urgent need for molecular profiling. As the therapeutic landscape shifts toward ultra-high-cost immunotherapies, establishing this historical baseline is essential for the development of sustainable, equity-driven health policies in middle-income countries.