To determine if implementation of the Patient Protection and Affordable Care Act (ACA) was subsequently associated with changes in one-year mortality in glioblastoma.

Glioblastoma carries a poor prognosis, and the current standard of care requires access to medical services including physicians, hospitals, surgery, chemotherapy and radiotherapy. The ACA, signed in 2010, sought to expand medical insurance coverage, most significantly through state-based opt-in expansion of Medicaid in 2014. Whether improved access to health insurance improved outcomes for glioblastoma patients is unknown.

A retrospective analysis was performed using the Surveillance, Epidemiology and End Results Database, and analyses were conducted using SEER*Stat and SAS. Using ICD-O-3 coding, we identified patients with primary diagnosis of glioblastoma between 2008 and 2016. Pre-expansion years were defined as 2008-2011, post-expansion was defined as 2014-2016. A multivariable adjusted Cox proportional hazards model was developed using patient and clinical characteristics to determine one-year mortality risk by expansion status.

A total of 25,784 cases were identified and included in the analysis. Overall one-year mortality for glioblastoma patients in non-expansion states did not significantly worsen compared to expansion states (2008-2010: HR 1.11 [95% CI 1.04 – 1.19], 2014-2016: HR 1.18 [95% CI 1.09 – 1.27]). However, in glioblastoma patients younger than age 65 at diagnosis, there was a trend toward poorer one-year survival in non-expansion states (2008-2010: HR 1.09 [95% CI 0.97 – 1.22], 2014-2016: HR 1.23 [95% CI 1.09 – 1.40]).

No differences were found in overall mortality for glioblastoma patients in expansion versus non-expansion states. However, results suggest that glioblastoma patients in expansion states diagnosed under the age of 65 experienced greater improvements in mortality following implementation of the ACA.