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

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

*Corresponding author for this work

Research output: Contribution to journalReviewResearchpeer-review

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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.

Original languageEnglish
Article number2013
JournalInternational Journal of Environmental Research and Public Health
Volume15
Issue number9
Number of pages24
ISSN1661-7827
DOIs
Publication statusPublished - 14. Sep 2018

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European Union
Hepatitis
Cost-Benefit Analysis
Health Priorities
Health
Chronic Hepatitis C
Liver Neoplasms
Liver Diseases
Hepatocellular Carcinoma
Public Health
Clinical Trials
Population

Keywords

  • European Union
  • Hepatitis C
  • Migrants
  • Screening
  • Viral hepatitis elimination
  • Mass Screening/economics
  • Humans
  • Hepatitis C/complications
  • Ethnic Groups
  • Antiviral Agents/therapeutic use
  • Cost-Benefit Analysis
  • Transients and Migrants
  • Liver Neoplasms/prevention & control
  • Carcinoma, Hepatocellular/prevention & control

Cite this

Greenaway, Christina ; Makarenko, Iuliia ; Chakra, Claire Nour Abou ; Alabdulkarim, Balqis ; Christensen, Robin ; Palayew, Adam ; Tran, Anh ; Staub, Lukas ; Pareek, Manish ; Meerpohl, Joerg J. ; Noori, Teymur ; Veldhuijzen, Irene ; Pottie, Kevin ; Castelli, Francesco ; Morton, Rachael L. / The effectiveness and cost-effectiveness of hepatitis c screening for migrants in the EU/EEA : A systematic review. In: International Journal of Environmental Research and Public Health. 2018 ; Vol. 15, No. 9.
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title = "The effectiveness and cost-effectiveness of hepatitis c screening for migrants in the EU/EEA: A systematic review",
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, Mass Screening/economics, Humans, Hepatitis C/complications, Ethnic Groups, Antiviral Agents/therapeutic use, Cost-Benefit Analysis, Transients and Migrants, Liver Neoplasms/prevention & control, Carcinoma, Hepatocellular/prevention & control",
author = "Christina Greenaway and Iuliia Makarenko and Chakra, {Claire Nour Abou} and Balqis Alabdulkarim and Robin Christensen and Adam Palayew and Anh Tran and Lukas Staub and Manish Pareek and Meerpohl, {Joerg J.} and Teymur Noori and Irene Veldhuijzen and Kevin Pottie and Francesco Castelli and Morton, {Rachael L.}",
year = "2018",
month = "9",
day = "14",
doi = "10.3390/ijerph15092013",
language = "English",
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journal = "International Journal of Environmental Research and Public Health",
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Greenaway, C, Makarenko, I, Chakra, CNA, Alabdulkarim, B, Christensen, R, Palayew, A, Tran, A, Staub, L, Pareek, M, Meerpohl, JJ, Noori, T, Veldhuijzen, I, Pottie, K, Castelli, F & Morton, RL 2018, 'The effectiveness and cost-effectiveness of hepatitis c screening for migrants in the EU/EEA: A systematic review', International Journal of Environmental Research and Public Health, vol. 15, no. 9, 2013. https://doi.org/10.3390/ijerph15092013

The effectiveness and cost-effectiveness of hepatitis c screening for migrants in the EU/EEA : A systematic review. / Greenaway, Christina; Makarenko, Iuliia; Chakra, Claire Nour Abou; Alabdulkarim, Balqis; Christensen, Robin; Palayew, Adam; Tran, Anh; Staub, Lukas; Pareek, Manish; Meerpohl, Joerg J.; Noori, Teymur; Veldhuijzen, Irene; Pottie, Kevin; Castelli, Francesco; Morton, Rachael L.

In: International Journal of Environmental Research and Public Health, Vol. 15, No. 9, 2013, 14.09.2018.

Research output: Contribution to journalReviewResearchpeer-review

TY - JOUR

T1 - The effectiveness and cost-effectiveness of hepatitis c screening for migrants in the EU/EEA

T2 - A systematic review

AU - Greenaway, Christina

AU - Makarenko, Iuliia

AU - Chakra, Claire Nour Abou

AU - Alabdulkarim, Balqis

AU - Christensen, Robin

AU - Palayew, Adam

AU - Tran, Anh

AU - Staub, Lukas

AU - Pareek, Manish

AU - Meerpohl, Joerg J.

AU - Noori, Teymur

AU - Veldhuijzen, Irene

AU - Pottie, Kevin

AU - Castelli, Francesco

AU - Morton, Rachael L.

PY - 2018/9/14

Y1 - 2018/9/14

N2 - 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.

AB - 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.

KW - European Union

KW - Hepatitis C

KW - Migrants

KW - Screening

KW - Viral hepatitis elimination

KW - Mass Screening/economics

KW - Humans

KW - Hepatitis C/complications

KW - Ethnic Groups

KW - Antiviral Agents/therapeutic use

KW - Cost-Benefit Analysis

KW - Transients and Migrants

KW - Liver Neoplasms/prevention & control

KW - Carcinoma, Hepatocellular/prevention & control

U2 - 10.3390/ijerph15092013

DO - 10.3390/ijerph15092013

M3 - Review

C2 - 30223539

AN - SCOPUS:85053680384

VL - 15

JO - International Journal of Environmental Research and Public Health

JF - International Journal of Environmental Research and Public Health

SN - 1661-7827

IS - 9

M1 - 2013

ER -