1. Hepatitis C virus prevalence and level of intervention required to achieve the WHO targets for elimination in the European Union by 2030: a modelling study
- Author
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Wolfgang Vogel, M. Blachier, Lelia Thornton, Wim Laleman, Ieva Tolmane, Antonio Craxì, Mojca Matičič, Hans Van Vlierberghe, Christoph Sarrazin, Laura Harcouet, Joël Mossong, Ilias Gountas, Matthew E. Cramp, Devin Razavi-Shearer, Soo Aleman, Lyudmila Mateva, Ann-Sofi Duberg, Vratislav Nemecek, Jordan Genov, Michael Manns, Anne Øvrehus, Irena Hrstić, Kimberly Murphy, Stefano Vella, Krzysztof Tomasiewicz, Francesco Negro, Nina Weis, Antonio Javier Blasco, Agita Jeruma, Karolin Falconer, Danute Speiciene, Jonas Valantinas, Jose Luis Calleja, Jan Sperl, Gabor Horvath, Filipe Calinas, Peter Jarcuska, Jerneja Videčnik-Zorman, Ivan Schréter, Kathryn Razavi-Shearer, Christophe Moreno, Sergeja Gregorčič, Angelos Hatzakis, Pierre Van Damme, Riina Salupere, Massimo Colombo, Robert J. de Knegt, Peter J Smit, Dijana Nonkovic, Daniela K van Santen, Waldemar Halota, Rui Sarmento-Castro, Jean-Michel Delile, Suzanne Norris, Vana Sypsa, Robert Flisiak, Carole Seguin-Devaux, Martin Lagging, Liana Gheorghe, Mihály Makara, Javier García-Samaniego, Christophe Hézode, Jennifer Kieran, Marian Oltman, Peter Stärkel, Victor de Ledinghen, Pablo Lázaro, Stefan Zeuzem, E. A. Croes, Patrick Hoffmann, Matti Maimets, Francesco Saverio Mennini, Kostas Athanasakis, Chris Estes, Stephen D. Ryder, Sarah Robbins, Françoise Roudot-Thoraval, Martin Kåberg, Kaarlo Simojoki, Sona Frankova, Adrian Goldis, Marietta Simonova, Kyriakos Souliotis, Ken Pasini, Homie Razavi, Rui Tato Marinho, Sarah Blach, Pavol Kristian, Rumiana Mitova, Loreta A. Kondili, Maria Buti, Helen Nde, Boris Lukšić, Henrik Krarup, Dominique Vandijck, Henk W. Reesink, David A. M. C. van de Vijver, Iskren Kotzev, Jessie Gunter, Adriaan J. van der Meer, Martti Färkkilä, Baiba Rozentale, Perttu Arkkila, Krasimir Antonov, Jan Gerstoft, Béla Hunyady, Peer Brehm Christensen, Ivane Gamkrelidze, Valentina Liakina, Michael Gschwantler, Deian Jelev, Tatjana Reic, George V. Papatheodoridis, Jonathan Schmelzer, Daniel Struck, Gastroenterology & Hepatology, Razavi, Homie, Robbins, Sarah, Zeuzem, Stefan, Negro, Francesco, Buti, Maria, Duberg, Ann-Sofi, Roudot-Thoraval, Françoise, Craxi, Antonio, Manns, Michael, Marinho, Rui T, Hunyady, Bela, Colombo, Massimo, Aleman, Soo, Antonov, Krasimir, Arkkila, Perttu, Athanasakis, Kosta, Blach, Sarah, Blachier, Martin, Blasco, Antonio J, Calinas, Filipe, Calleja, Jose L, Christensen, Peer B, Cramp, Matthew E, Croes, Esther, de Knegt, Robert J, de Ledinghen, Victor, Delile, Jean-Michel, Estes, Chri, Falconer, Karolin, Färkkilä, Martti, Flisiak, Robert, Frankova, Sona, Gamkrelidze, Ivane, GarcÃa-Samaniego, Javier, Genov, Jordan, Gerstoft, Jan, Gheorghe, Liana, Goldis, Adrian, Gountas, Ilia, GregorÄ iÄ , Sergeja, Gschwantler, Michael, Gunter, Jessie, Halota, Waldemar, Harcouet, Laura, Hézode, Christophe, Hoffmann, Patrick, Horvath, Gabor, Hrstic, Irena, JarÄ uÅ¡ka, Peter, Jelev, Deian, Jeruma, Agita, KÃ¥berg, Martin, Kieran, Jennifer, Kondili, Loreta A, Kotzev, Iskren, Krarup, Henrik, Kristian, Pavol, Lagging, Martin, Laleman, Wim, Lázaro, Pablo, Liakina, Valentina, LukÅ¡iÄ , Bori, Maimets, Matti, Makara, Mihály, Mateva, Lyudmila, Maticic, Mojca, Mennini, Francesco S, Mitova, Rumiana, Moreno, Christophe, Mossong, Joel, Murphy, Kimberly, Nde, Helen, Nemecek, Vratislav, Nonkovic, Dijana, Norris, Suzanne, Oltman, Marian, à vrehus, Anne L H, Papatheodoridis, George, Pasini, Ken, Razavi-Shearer, Devin, Razavi-Shearer, Kathryn, Reesink, Henk W, Reic, Tatjana, Rozentale, Baiba, Ryder, Stephen D, Salupere, Riina, Sarmento-Castro, Rui, Sarrazin, Christoph, Schmelzer, Jonathan D, Schréter, Ivan, Seguin-Devaux, Carole, Simojoki, Kaarlo, Simonova, Marietta, Smit, Peter J, Souliotis, Kyriako, Speiciene, Danute, Sperl, Jan, Stärkel, Peter, Struck, Daniel, Sypsa, Vana, Thornton, Lelia, Tolmane, Ieva, Tomasiewicz, Krzysztof, Valantinas, Jona, Van Damme, Pierre, van de Vijver, David, van der Meer, Adriaan J, van Santen, Daniela, Van Vlierberghe, Han, Vandijck, Dominique, Vella, Stefano, VideÄ nik-Zorman, Jerneja, Vogel, Wolfgang, Weis, Nina, Hatzakis, Angelos, European Union HCV Collaborators, and Faculteit Medische Wetenschappen/UMCG
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Pediatrics ,ddc:616.07 ,medicine.disease_cause ,0302 clinical medicine ,Cost of Illness ,Epidemiology ,Prevalence ,EPIDEMIOLOGY ,030212 general & internal medicine ,Settore SECS-P/01 - Economia Politica ,CIRRHOSIS ,media_common ,ddc:616 ,Antiviral Agents/therapeutic use ,education.field_of_study ,INJECT DRUGS ,Gastroenterology ,HCV INFECTION ,virus diseases ,Hepatitis C ,Emigration and Immigration ,DISEASE BURDEN ,Markov Chains ,Emigration and Immigration/statistics & numerical data ,030211 gastroenterology & hepatology ,Viral hepatitis ,Modelling ,Eradication ,European Union ,prevalence ,COUNTRIES ,medicine.medical_specialty ,Hepatitis C virus ,Population ,UNITED-STATES ,World Health Organization ,Antiviral Agents ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,PEOPLE ,Internal medicine ,Intervention (counseling) ,medicine ,Journal Article ,media_common.cataloged_instance ,Humans ,Viremia ,European union ,Disease Eradication ,education ,Hepatitis C/diagnosis/drug therapy/epidemiology/prevention & control ,Hepatology ,business.industry ,Viremia/diagnosis/drug therapy/epidemiology/prevention & control ,medicine.disease ,Virology ,PREVENTION ,digestive system diseases ,Human medicine ,VIRAL-HEPATITIS ,business - Abstract
Background Hepatitis C virus (HCV) is a leading cause of liver-related morbidity and mortality worldwide. In the European Union (EU), treatment and cure of HCV with direct-acting antiviral therapies began in 2014. WHO targets are to achieve a 65% reduction in liver-related deaths, a 90% reduction of new viral hepatitis infections, and 90% of patients with viral hepatitis infections being diagnosed by 2030. This study assessed the prevalence of HCV in the EU and the level of intervention required to achieve WHO targets for HCV elimination. Methods We populated country Markov models for the 28 EU countries through a literature search of PubMed and Embase between Jan 1, 2000, and March 31, 2016, and a Delphi process to gain expert consensus and validate inputs. We aggregated country models to create a regional EU model. We used the EU model to forecast HCV disease progression (considering the effect of immigration) and developed a strategy to acehive WHO targets. We used weighted average sustained viral response rates and fibrosis restrictions to model the effect of current therapeutic guidelines. We used the EU model to forecast HCV disease progression (considering the effect of immigration) under current screening and therapeutic guidelines. Additionally, we back-calculated the total number of patients needing to be screened and treated to achieve WHO targets. Findings We estimated the number of viraemic HCV infections in 2015 to be 3â238â000 (95% uncertainty interval [UI] 2â106â000â3â795â000) of a total population of 509â868â000 in the EU, equating to a prevalence of viraemic HCV of 0·64% (95% UI 0·41â0·74). We estimated that 1â180â000 (95% UI 1â003â000â1â357â000) people were diagnosed with viraemia (36·4%), 150â000 (12â000â180â000) were treated (4·6% of the total infected population or 12·7% of the diagnosed population), 133â000 (106â000â160â000) were cured (4·1%), and 57â900 (43â900â67â300) were newly infected (1·8%) in 2015. Additionally, 30â400 (26â600â42â500) HCV-positive immigrants entered the EU. To achieve WHO targets, unrestricted treatment needs to increase from 150â000 patients in 2015 to 187â000 patients in 2025 and diagnosis needs to increase from 88â800 new cases annually in 2015 to 180â000 in 2025. Interpretation Given its advanced health-care infrastructure, the EU is uniquely poised to eliminate HCV; however, expansion of screening programmes is essential to increase treatment to achieve the WHO targets. A united effort, grounded in sound epidemiological evidence, will also be necessary. Funding Gilead Sciences.
- Published
- 2017