International Journal of Environmental Research and Public Health
Volume 15, Issue 9, 2018

The effectiveness and cost-effectiveness of hepatitis c screening for migrants in the EU/EEA: A systematic review (Review) (Open Access)

Greenaway C.* , Makarenko I. , Chakra C.N.A. , Alabdulkarim B. , Christensen R. , Palayew A. , Tran A. , Staub L. , Pareek M. , Meerpohl J.J. , Noori T. , Veldhuijzen I. , Pottie K. , Castelli F. , Morton R.L.
  • a Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada, Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada, Department of Epidemiology, Biostatistics, and Occupational, Health, McGill University, Montreal, QC H3A 1A2, Canada
  • b Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
  • c Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, QC J1H 5NG, Canada
  • d Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
  • e Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital & Department of Rheumatology, Odense University Hospital, Odense, DK2000, Denmark
  • f Department of Epidemiology, Biostatistics, and Occupational, Health, McGill University, Montreal, QC H3A 1A2, Canada
  • g NHMRC Clinical Trials Centre, The University of Sydney, Sydney, 1450, Australia
  • h NHMRC Clinical Trials Centre, The University of Sydney, Sydney, 1450, Australia
  • i Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, LE1 7RH, United Kingdom
  • j Institute for Evidence in Medicine for Cochrane Germany Foundation, Medical Center, University of Freiburg, Freiburg, 79110, Germany
  • k European Centre for Disease Prevention and Control, Solna, 169 73, Sweden
  • l Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, 3720 BA, Netherlands
  • m C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1N 5C8, Canada, Centre for Global Health, University of Ottawa, Ottawa, ON K1N 5C8, Canada
  • n Division of Infectious Diseases, University of Brescia, Brescia, 255123, Italy
  • o NHMRC Clinical Trials Centre, The University of Sydney, Sydney, 1450, Australia

Abstract

Chronic hepatitis C (HCV) is a public health priority in the European Union/European Economic Area (EU/EEA) and is a leading cause of chronic liver disease and liver cancer. Migrants account for a disproportionate number of HCV cases in the EU/EEA (mean 14% of cases and >50% of cases in some countries). We conducted two systematic reviews (SR) to estimate the effectiveness and cost-effectiveness of HCV screening for migrants living in the EU/EEA. We found that screening tests for HCV are highly sensitive and specific. Clinical trials report direct acting antiviral (DAA) therapies are well-tolerated in a wide range of populations and cure almost all cases (>95%) and lead to an 85% lower risk of developing hepatocellular carcinoma and an 80% lower risk of all-cause mortality. At 2015 costs, DAA based regimens were only moderately cost-effective and as a result less than 30% of people with HCV had been screened and less 5% of all HCV cases had been treated in the EU/EEA in 2015. Migrants face additional barriers in linkage to care and treatment due to several patient, practitioner, and health system barriers. Although decreasing HCV costs have made treatment more accessible in the EU/EEA, HCV elimination will only be possible in the region if health systems include and treat migrants for HCV. © 2018, MDPI AG. All rights reserved.

Author Keywords

Screening Migrants Viral hepatitis elimination Hepatitis C European Union

Index Keywords

incremental cost effectiveness ratio liver tumor Liver Neoplasms Cost benefit analysis mass screening economics all cause mortality Europe health risk disease treatment health disparity complication Carcinoma, Hepatocellular human risk assessment Antiviral Agents Ethnic Groups interferon ethnic group Hepatitis C virus cancer risk chronic hepatitis C screening test quality adjusted life year health care cost Humans migrant health economics hepatitis C virology Treatment Outcome health impact assessment direct acting antiviral therapy accessibility Review diagnostic test high risk population liver cell carcinoma European Union prevalence hepatitis peginterferon health care disease control health care utilization medical service cost control migration ribavirin health care access drug tolerability disease elimination mortality point of care testing antiviral therapy Transients and Migrants antivirus agent systematic review cost-benefit analysis enzyme immunoassay clinical effectiveness public health cost effectiveness analysis early diagnosis immigrant population
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85053680384&doi=10.3390%2fijerph15092013&partnerID=40&md5=95253807b9be4560cd3c26026d529ce0
DOI: 10.3390/ijerph15092013
ISSN: 16617827
Cited by: 6
Original Language: English