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. 2018 Sep 14;15(9):2013.
doi: 10.3390/ijerph15092013.

The Effectiveness and Cost-Effectiveness of Hepatitis C Screening for Migrants in the EU/EEA: A Systematic Review

Christina Greenaway  1   2   3 , Iuliia Makarenko  4 , Claire Nour Abou Chakra  5 , Balqis Alabdulkarim  6 , Robin Christensen  7 , Adam Palayew  8 , Anh Tran  9 , Lukas Staub  10 , Manish Pareek  11 , Joerg J Meerpohl  12 , Teymur Noori  13 , Irene Veldhuijzen  14 , Kevin Pottie  15   16 , Francesco Castelli  17 , Rachael L Morton  18
Affiliations

The Effectiveness and Cost-Effectiveness of Hepatitis C Screening for Migrants in the EU/EEA: A Systematic Review

Christina Greenaway et al. Int J Environ Res Public Health. .

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.

Keywords: European Union; hepatitis C; migrants; screening; viral hepatitis elimination.

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Conflict of interest statement

C.G. was the first author on five of the infectious disease conditions including hepatitis C in the Canadian Migrant Health Guidelines; K.P. led the overall guidelines. M.P. reports an institutional grant (unrestricted) for project related to blood-borne virus testing from Gilead Sciences outside the submitted work. I.M., C.N.A.C., B.A., A.P., I.V., F.C., R.M., A.T., L.S., J.J.M., R.C., and T.N. declare no conflicts of interest. The funding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram for the effectiveness of hepatitis C screening.
Figure 2
Figure 2
PRISMA diagram for the resource use, costs, and cost-effectiveness for hepatitis C screening.
See this image and copyright information in PMC

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