Socioeconomic Status and Financial Implications in High Grade Glioma Resection: A Retrospective Study

Introduction: Financial hardship is an often overlooked component of healthcare that has been implicated in reduced survival rates in various disease states. Our study aims to elucidate this effect in high grade glioma patients with the goal of uncovering new domains for the treatment of these patients.

Methods: We retrospectively evaluated 131 patients with newly diagnosed, high grade (grade III/IV) gliomas from a single institution between 2014 - 2021. Using the UW Neighborhood Atlas ADI (area deprivation index), we dichotomized patients into low SES (socioeconomic status) (ADI >=5) and high SES (ADI < 5) cohorts and analyzed their financial burden and survival utilizing descriptive and univariate analyses. Primary outcomes included out-of-pocket expenses, debt accumulation (collections notice), and overall survival.

Results: Patients with high grade glioma had a median survival of 0.9 and 1.0 years for low SES and high SES respectively (p = 0.26). Patients from high SES more likely received combination chemotherapy and radiation (p =0.007). Married patients had an overall lower risk of going to collections (p=0.023), while low SES patients were more likely to face collections (p=0.04). Those with private insurance accrued higher costs associated with the procedure ($1093 vs $506, [p < 0.001]) and were 9.9 times more likely to pay out-of-pocket when compared to public insurance holders (p <.001). Private insurance holders also had a higher risk of mortality (p=0.012) compared to public insurance holders, and uninsured patients faced a 4.6 times greater mortality risk than those with public insurance (p <.001).

Conclusion : Our results suggest there may be an association between SES and treatment paradigms following high grade glioma resection. They also shed light on some of the financial implications associated with the breadth of care for these patients.