• Healthcare expenditures among community-dwelling adults with thyroid cancer in the United States: A propensity score matched analysis

      Bhattacharjee, Sandipan; Khobrani, Moteb; Alrabiah, Ziyad; Bilal, Jawad; Riaz, Irbaz Bin; Univ Arizona, Coll Pharm, Dept Pharm Practice & Sci; Univ Arizona, Coll Pharm, Hlth Outcomes & PharmacoEcon Res Hope Ctr; Univ Arizona, Dept Internal Med (ELSEVIER SCI LTD, 2019-06)
      Objective: This study assessed the excess healthcare expenditures and factors associated with it among community-dwelling adults with thyroid cancer compared to non-cancer controls in the United States. Method: A retrospective, cross-sectional, matched case-control study design was used by pooling multiple years of Medical Expenditure Panel Survey (MEPS) data (2002-2012). The eligible study sample comprised of adults (age >= 18 years), who were alive during the calendar year and reported positive healthcare expenditure. The case group consisted of adults with thyroid cancer only while the control group consisted of adults who did not have any form of cancer. Total and subtypes of mean annual healthcare expenditures comprised the main study outcome. We also calculated the total and subtypes of out-of-pocket (OOP) expenditures as well as OOP as a percentage of household income. Ordinary Least Square (OLS) regressions on log-transformed expenditures were conducted to elucidate the influence of different factors on healthcare expenditures among adults with thyroid cancer. Results: The yearly average total healthcare expenditures among adults with thyroid cancer was significantly higher compared to propensity score matched controls ($9,585 vs. $5,830, p < 0.001). Similar observations were found in terms of inpatient, and outpatient expenditures. Functional status as well as comorbid conditions were significantly associated with excess expenditures. The yearly average total OOP expenditure for adults with thyroid cancer was significantly higher compared to matched controls ($1,425 vs. $974, p < 0.001), with major differences observed in inpatient OOP ($178 vs. $24, p = 0.003), outpatient OOP ($435vs. $256, p < 0.001), and prescription OOP ($554 vs. $423, p < 0.001) expenditures. There was a significant (p < 0.001) difference between the average OOP as a percentage of household income between adults with thyroid cancer (Mean: 7.54%, S.E: 1.52%) and matched controls (Mean: 5.80%, S.E: 0.47%). Conclusions: Our findings suggest that holistic care approach could be helpful to significantly reduce the economic burden in this population. Viable strategies such as limits on OOP costs are required to minimize this high OOP burden among cancer survivors and their families.
    • The use of strip-seeding for management of two late-season invasive plants

      Silva, Amanda Dechen; Roche, Leslie M; Gornish, Elise S; Univ Arizona (ELSEVIER SCI LTD, 2019-05)
      The spread and persistence of weedy plants in rangelands highlight the need for refinement of existing management techniques and development of novel strategies to address invasions. Strip-seeding - the strategic seeding of a portion of an invaded area to reduce costs and enhance success - is an underutilized management approach that holds promise for reducing weed dominance in grassland habitats. A strip-seeding experiment was established in 2011 in a California grassland where portions (between 0-100%) of invaded plots were seeded with native grasses. In 2016, we assessed the height, above-ground biomass and flower production of two late-season invasive plants: field bindweed and prickly lettuce. We found significant reductions in plant height and flower production (for both target invasives), and biomass (for field bindweed) in many of the seeded strips compared to the unseeded strips. Smaller seed applications demonstrated similar or better utility for weed control compared to greater seed applications, suggesting that this approach can be effective while reducing labor and materials cost of typical restoration management approaches. We did not find evidence that seeded strips provided invasion resistance to unseeded strips. This is possibly due to the lag in native species dispersal and establishment into contiguous unseeded strips, and suggests that strip-seeding might not provide invasion resistance to unseeded strips on timescales that are relevant to managers. However, this work does suggest that strip-seeding native species that overlap in phenology with target invasives can reduce late-season weed dominance on rangelands.