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

Christina Greenaway,Robin Christensen,Lukas Staub,Claire Abou Chakra,Anh Tran,Rachael Morton,Irene Veldhuijzen,Adam Palayew,Manish Pareek,Balqis Alabdulkarim,Joerg Meerpohl,Francesco Castelli,Kevin Pottie,Iuliia Makarenko,Teymur Noori

doi:10.3390/ijerph15092013

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.

Highlights

Introduction3.24 million persons having active hepatitis C virus (HCV) infection [1,2]
Chronic hepatitis C is an important public health problem in the EU/EEA, with an estimated3.24 million persons having active hepatitis C virus (HCV) infection [1,2]
We included five systematic reviews (SR) and one guideline that addressed the key questions along the screening evidence chain: the performance of HCV diagnostic tests (n = 2) [6,26], the impact of HCV treatment on preventing hepatocellular carcinoma (HCC) and all-cause mortality (n = 3) [27,28,29], and the HCV care continuum (n = 1) (Table 1) [30]

Summary

Introduction

3.24 million persons having active hepatitis C virus (HCV) infection [1,2]. It is a leading cause of chronic liver disease and liver cancer in the EU/EEA due to undetected and untreated infections [3,4,5]. Identifying and treating all groups at risk for HCV in the EU/EEA will be essential to address the health and economic burden due to HCV in the EU/EEA and to reach WHO elimination goals by 2030 [3,5,9,10,11]. Migrants from intermediate and high HCV prevalence countries (anti-HCV ≥ 2% and ≥5%, respectively) are an additional important and underappreciated group at increased HCV risk in the EU/EEA and often do not have identifiable

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