244 Background: Patterns of end-of-life healthcare utilization for patients with primary and secondary malignant brain tumors (PMBT, SMBT) are poorly understood. The primary objective of this study was to compare end-of-life healthcare utilization and expenditures between patients with PMBT and SMBT. The secondary objective was to determine risk factors for low-quality healthcare utilization at the end-of-life. Methods: We analyzed Medicare administrative claims data for decedents with a diagnosis of PMBT or SMBT within a community cancer network in the southeastern US from 2012-2015. Outcomes included hospital-based care (ED visit, hospitalization, and ICU admission), cancer therapy (chemo- or radiotherapy), hospice care, and total cost to Medicare in the last 30 days of life. We performed regression analyses to determine risk factors for each of the outcomes. Results: 1323 patients had a diagnosis of PMBT (383) or SMBT (940). Patients with SMBT received more hospital-based care (57% v 49%, p < 0.01) and more cancer therapy (25% v 18%, p < 0.01) than those with PMBT. Male gender (RR 1.28, p = 0.03) and decreasing age (RR 1.09, p = 0.02) were risk factors for PMBT and SMBT hospital-based care, respectively. While the majority of PMBT (81%) and SMBT patients (78%) utilized hospice care, those with SMBT were more likely to enroll ≤ 3 days prior to death (10% v 5%, p < 0.01). Hospital-based care (RR 5.22, p < 0.01 (PMBT); RR 5.24, p < 0.01 (SMBT)), and non-white race (RR 1.59, p = 0.04 (PMBT); RR 1.56, p < 0.01 (SMBT)) were risk factors for no hospice utilization. Mean expenditures in the last 30 days of life were similar between PMBT and SMBT ($8592 v $9964). Hospital-based care increased the average cost by $16,303 (PMBT, p<0.001) and $13,132 (SMBT, p<0.001). Conclusions: Hospitalization at the end-of-life is common in patients with PMBT or SMBT and is associated with lower rates of hospice care and increased expenditure.