Cost-Effectiveness of Community-Based Tobacco Dependence Treatment Interventions: Initial Findings of a Systematic Review.

INTRODUCTION: Scientific literature evaluating the cost-effectiveness of tobacco dependence treatment programs delivered in community-based settings is scant, which limits evidence-based tobacco control decisions. The aim of this review was to systematically assess the cost-effectiveness and quality of the economic evaluations of community-based tobacco dependence treatment interventions conducted as randomized controlled trials in the United States. METHODS: We searched 8 electronic databases and gray literature from their beginning to February 2018. Inclusion criteria were economic evaluations of community-based tobacco dependence treatments conducted as randomized controlled trials in the United States. Two independent researchers extracted data on study design and outcomes. Study quality was assessed by using Drummond and Jefferson's economic evaluations checklist. Nine of 3,840 publications were eligible for inclusion. Heterogeneity precluded formal meta-analyses. We synthesized a qualitative narrative of outcomes. RESULTS: All 9 studies used cost-effectiveness analysis and a payer/provider/program perspective, but several study components, such as abstinence measures, were heterogeneous. Study participants were predominantly English speaking, middle aged, white, motivated to quit, and highly nicotine dependent. Overall, the economic evaluations met most of Drummond and Jefferson's recommendations; however, some studies provided limited details. All studies had a cost per quit at or below $2,040 or an incremental cost-effectiveness ratio (ICER) at or below $3,781. When we considered biochemical verification, sensitivity analysis, and subgroups, the costs per quit were less than $2,050 or the ICERs were less than $6,800. CONCLUSION: All community-based interventions included in this review were cost-effective. When economic evaluation results are extrapolated to future savings, the low cost per quit or ICER indicates that the cost-effectiveness of community-based tobacco dependence treatments is similar to the cost-effectiveness of clinic-based programs and that community-based interventions are a valuable approach to tobacco control. Additional research that more fully characterizes the cost-effectiveness of community-based tobacco dependence treatments is needed to inform future decisions in tobacco control policy.

Omega-3 fatty acids in juvenile idiopathic arthritis: effect on cytokines (IL-1 and TNF-α), disease activity and response criteria.

This study aims to demonstrate the effect of omega-3 fatty acids (ω-3 FAs) supplements on the clinical manifestations, laboratory investigations, disease activity, functional capacity, response criteria as well as interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) levels in juvenile idiopathic arthritis (JIA) patients. Twenty-seven JIA patients were included in this study. Dietary supplements of ω-3 FAs 2 g/day were given for 12 weeks. Juvenile arthritis disease activity score in 27 joints (JADAS-27) and pediatric American College of Rheumatology (ACR) response criteria were determined. Childhood Health Assessment Questionnaire (CHAQ) was used to measure the functional status. Assessment of serum IL-1 and TNF-α level was performed using enzyme-linked immunosorbent assay. The mean age of the patients was 12.78 ± 3.26 years, the disease duration was 5.93 ± 3.06 years, and the age at disease onset was 6.78 ± 3.26 years. The TNF-α and IL-1 were significantly higher in the JIA patients compared to the control. There was a significant improvement of active joint count, number of swollen joints, JADAS-27, CHAQ, TNF-α, and IL-1 levels. The pediatric ACR response criteria improved in 92.59% of the patients. The daily requirements of nonsteroidal anti-inflammatory drugs (NSAIDs) obviously decreased. ω-3 FAs supplements reduce the inflammatory response and improve the clinical manifestation in JIA patient. The daily intake of NSAID dose decreased thus reducing the risk of related side effects. Our results support the use of omega-3 fatty acids as an add-on therapy to conventional treatment of JIA.