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. 2022 Feb;42(2):330-339.
doi: 10.1111/liv.15111. Epub 2021 Dec 10.

HCV disease burden and population segments in Switzerland

Florian Bihl  1   2 , Philip Bruggmann  3 , Erika Castro Batänjer  4 , Jean-Francois Dufour  5 , Daniel Lavanchy  6 , Beat Müllhaupt  7 , Francesco Negro  8 , Homie Razavi  9 , Claude Scheidegger  10 , David Semela  11 , Nasser Semmo  12 , Sarah Blach  9
Affiliations

HCV disease burden and population segments in Switzerland

Florian Bihl et al. Liver Int. 2022 Feb.

Abstract

Background: Switzerland has made strides towards hepatitis C virus elimination, but as of 2019, elimination was not guaranteed. However, political interest in viral hepatitis has been increasing. We sought to develop a better understanding of Switzerland's progress towards HCV elimination and the profile of remaining HCV-RNA-positive patients.

Methods: A previously described Markov model was updated with recent diagnosis and treatment data and run to generate new forecasts for HCV disease burden. Two scenarios were developed to evaluate HCV morbidity and mortality under the status quo and a scenario that achieves the Swiss Hepatitis Strategy Elimination targets. Next, an analysis was conducted to identify population segments bearing a high burden of disease, where future elimination efforts could be directed.

Results: At the beginning of 2020, an estimated 32 100 viremic infections remained in Switzerland (0.37% viremic prevalence). Adult (≥18 years of age) permanent residents born abroad represented the largest subpopulation, accounting for 56% of HCV infections. Thirteen countries accounted for ≥60% of viremic infections amongst permanent residents born abroad, with most people currently residing in Zurich, Vaud, Geneva, Bern, Aargau and Ticino. Amongst Swiss-born HCV-RNA-positive persons, two-thirds had a history of IDU, corresponding to 33% of total infections.

Conclusions: In Switzerland, extra efforts for diagnosis and linkage to care are warranted in foreign-born populations and people with a history of drug use. Population-level measures (eg increasing the number of providers, increase screening) can identify patients who may have otherwise fallen through the gaps or avoided care because of stigma.

Keywords: Switzerland; elimination; hepatitis C Virus; migration.

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Conflict of interest statement

PB has received speaker honoraria and project and research grants from AbbVie and Gilead and project grants from the Swiss Federal Office of Public Health. ECB has received grants from AbbVie and Gilead and has been an expert advisor for ViiV Health Sciences in Switzerland. J‐FD has been a member of advisory boards for Abbvie, Bayer, Bristol‐Myers Squibb, Falk, Genfit, Genkyotex, Gilead Sciences, HepaRegenix, Intercept, Lilly, Merck, Novartis, Roche. Speaking and teaching: Bayer, Bristol‐Myers Squibb, Intercept, Genfit, Gilead Sciences, Novartis and Roche. BM has received speaker and/or consulting fees from Merck/MSD, AbbVie, Intercept, Astra, Bayer, BMS, Gilead and research support from Gilead. FN has received grant support from Gilead and advisor fees and travel grants from Gilead and AbbVie. HR has been a member of advisory boards for Gilead, AbbVie, Merck and VBI Vaccines. All proceeds are donated to CDAF. He is the managing director of Center for Disease Analysis (CDA) and CDAF. CS has been a member of advisory boards for Gilead, AbbVie and Merck. He has received fees for presentations in the context of continuous medical education from various institutions including public and private sources. DS has received research grants, consulting fees and/or speaker fees from AbbVie, Gilead and MSD. NS has been a member of advisory boards for Gilead and AbbVie. SB is an employee of the Center for Disease Analysis Foundation (CDAF). Over the past 3 years, CDAF has received research funding from Gilead, AbbVie, and Vaccine Impact Modeling Consortium. CDAF has also received grants from CDC Foundation, John Martin Foundation, ASTHO, Zeshan Foundation, and private donors. FB has received speaker fees from Takeda. DL has no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Comparison of empirical diagnosis and treatment data from 2016 to 2020 against previously forecast scenarios published in Müllhaupt et al (2018). GHSS, global health sector strategy; SHS, Swiss hepatitis strategy
FIGURE 2
FIGURE 2
A, Change in viremic HCV infections in Switzerland from 2016 to 2020. B, Cascade of care in Switzerland, 2020
FIGURE 3
FIGURE 3
Annual number of treated patients and projected outcomes for total viremic infections, liver‐related deaths, and incident HCC amongst people with current viremic infection, under the base and SHS scenarios, 2015‐2030
See this image and copyright information in PMC

References

    1. Mullhaupt B, Bruggmann P, Bihl F, et al. Progress toward implementing the Swiss Hepatitis Strategy: is HCV elimination possible by 2030? PLoS One. 2018;13(12):e0209374. - PMC - PubMed
    1. Swiss Federal Office of Public Health Infectious Disease Numbers, Hepatitis C, totally 2020. https://www.bag.admin.ch. Accessed October 16, 2021.
    1. Swiss Hepatitis Strategy, 2014‐2030: Process Paper—A Living Document. 2019.
    1. The Federal Assembly—The Swiss Parliament . [Eliminate Hepatitis. Enrollment of the Disease in a National Sexually Transmitted and Blood‐Borne Infection Control Program]. 2019.
    1. Mullhaupt B, Bruggmann P, Bihl F, et al. Modeling the health and economic burden of hepatitis C virus in Switzerland. PLoS One. 2015;10(6):e0125214. - PMC - PubMed

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