# Global economic differences in modern glioblastoma care – a systematic review

## TL;DR

This paper reviews how the cost of treating glioblastoma varies globally, showing big differences between countries.

## Contribution

The study provides a systematic review of global economic differences in glioblastoma care and evaluates cost-effectiveness across healthcare systems.

## Key findings

- Direct medical costs for glioblastoma treatment range from $356,481 in the US to $18,908 in India.
- The Stupp protocol exceeds willingness-to-pay thresholds in middle-income countries.
- Tumor treating fields show varying cost-effectiveness ratios across different countries.

## Abstract

Glioblastoma (GBM) is the most aggressive form of primary brain cancer and is associated with poor overall survival and expensive, resource intensive treatments. We performed a systematic literature review to quantify the costs and cost-effectiveness of modern glioblastoma care across global healthcare systems.

A comprehensive literature search on PubMed, MEDLINE, and Cochrane databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the search string (Glioblastoma OR GBM) AND (costs OR cost-effectiveness OR economic burden) identified 21 studies eligible for our research question. Costs were reviewed for all treatment modalities of the current Stupp protocol. After considering the current consumer price indexes and purchasing power parities, these were then standardized to the value of US Dollars ($) in 2024.

A total of 15,547 real world GBM patients were analyzed. Direct medical costs displayed extreme heterogeneity, ranging from cumulative costs of $356,481 in the United States to approximately $18,908 in India. The Stupp protocol exceeded willingness-to-pay thresholds in middle income economies. Economic evaluations of Tumor treating fields revealed Incremental Cost-Effectiveness Ratios (ICER) ranging from $862,361.37 to $940,344.39 per Life Year Gained (LYG) in France to $252,590.08 per LYG in the United States, and a more favorable per Quality Adjusted Life Year (QALY) of $45,813.91 in China.

The cost of modern GBM treatment varies greatly between the analyzed countries with adjuvant treatment and inpatient care being the most important cost drivers in western countries in the direct medical costs analyses. Cost models show that the Stupp protocol remains a significant financial burden in resource-limited settings, underlining the cost-effectiveness of surgery in modern GBM management. There is, however, a need for uniform cost reporting to correctly assess cost-effectiveness across global healthcare systems.