TY - JOUR
T1 - Hepatitis C virus prevalence and level of intervention required to achieve the WHO targets for elimination in the European Union by 2030
T2 - a modelling study
AU - Razavi, Homie
AU - Robbins, Sarah
AU - Zeuzem, Stefan
AU - Negro, Francesco
AU - Buti, Maria
AU - Duberg, Ann Sofi
AU - Roudot-Thoraval, Françoise
AU - Craxi, Antonio
AU - Manns, Michael
AU - Marinho, Rui T.
AU - Hunyady, Bela
AU - Colombo, Massimo
AU - Aleman, Soo
AU - Antonov, Krasimir
AU - Arkkila, Perttu
AU - Athanasakis, Kostas
AU - Blach, Sarah
AU - Blachier, Martin
AU - Blasco, Antonio J.
AU - Calinas, Filipe
AU - Calleja, Jose L.
AU - Christensen, Peer B.
AU - Cramp, Matthew E.
AU - Croes, Esther
AU - de Knegt, Robert J.
AU - de Ledinghen, Victor
AU - Delile, Jean Michel
AU - Estes, Chris
AU - Falconer, Karolin
AU - Färkkilä, Martti
AU - Flisiak, Robert
AU - Frankova, Sona
AU - Gamkrelidze, Ivane
AU - García-Samaniego, Javier
AU - Genov, Jordan
AU - Gerstoft, Jan
AU - Gheorghe, Liana
AU - Goldis, Adrian
AU - Gountas, Ilias
AU - Gregorčič, Sergeja
AU - Gschwantler, Michael
AU - Gunter, Jessie
AU - Halota, Waldemar
AU - Harcouet, Laura
AU - Hézode, Christophe
AU - Hoffmann, Patrick
AU - Horvath, Gabor
AU - Hrstic, Irena
AU - Jarčuška, Peter
AU - Seguin-Devaux, Carole
AU - The European Union HCV Collaborators
N1 - Publisher Copyright:
© 2017 Elsevier Ltd
PY - 2017/5/1
Y1 - 2017/5/1
N2 - 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 3 238 000 (95% uncertainty interval [UI] 2 106 000–3 795 000) of a total population of 509 868 000 in the EU, equating to a prevalence of viraemic HCV of 0·64% (95% UI 0·41–0·74). We estimated that 1 180 000 (95% UI 1 003 000–1 357 000) people were diagnosed with viraemia (36·4%), 150 000 (12 000–180 000) were treated (4·6% of the total infected population or 12·7% of the diagnosed population), 133 000 (106 000–160 000) were cured (4·1%), and 57 900 (43 900–67 300) were newly infected (1·8%) in 2015. Additionally, 30 400 (26 600–42 500) HCV-positive immigrants entered the EU. To achieve WHO targets, unrestricted treatment needs to increase from 150 000 patients in 2015 to 187 000 patients in 2025 and diagnosis needs to increase from 88 800 new cases annually in 2015 to 180 000 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.
AB - 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 3 238 000 (95% uncertainty interval [UI] 2 106 000–3 795 000) of a total population of 509 868 000 in the EU, equating to a prevalence of viraemic HCV of 0·64% (95% UI 0·41–0·74). We estimated that 1 180 000 (95% UI 1 003 000–1 357 000) people were diagnosed with viraemia (36·4%), 150 000 (12 000–180 000) were treated (4·6% of the total infected population or 12·7% of the diagnosed population), 133 000 (106 000–160 000) were cured (4·1%), and 57 900 (43 900–67 300) were newly infected (1·8%) in 2015. Additionally, 30 400 (26 600–42 500) HCV-positive immigrants entered the EU. To achieve WHO targets, unrestricted treatment needs to increase from 150 000 patients in 2015 to 187 000 patients in 2025 and diagnosis needs to increase from 88 800 new cases annually in 2015 to 180 000 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.
UR - http://www.scopus.com/inward/record.url?scp=85017271819&partnerID=8YFLogxK
U2 - 10.1016/S2468-1253(17)30045-6
DO - 10.1016/S2468-1253(17)30045-6
M3 - Article
C2 - 28397696
AN - SCOPUS:85017271819
SN - 2468-1253
VL - 2
SP - 325
EP - 336
JO - The Lancet Gastroenterology and Hepatology
JF - The Lancet Gastroenterology and Hepatology
IS - 5
ER -