The Effectiveness and Cost-Effectiveness of Hepatitis C Screening for Migrants in the EU/EEA: A Systematic Review
by
Christina Greenaway 1,2,3,*, Iuliia Makarenko 2, Claire Nour Abou Chakra 4, Balqis Alabdulkarim 2, Robin Christensen 5, Adam Palayew 3
, Anh Tran 6, Lukas Staub 6, Manish Pareek 7, Joerg J. Meerpohl 8, Teymur Noori 9, Irene Veldhuijzen 10, Kevin Pottie 11,12, Francesco Castelli 13,†,‡ and Rachael L. Morton 6
, Anh Tran 6, Lukas Staub 6, Manish Pareek 7, Joerg J. Meerpohl 8, Teymur Noori 9, Irene Veldhuijzen 10, Kevin Pottie 11,12, Francesco Castelli 13,†,‡ and Rachael L. Morton 6
1
Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
2
Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
3
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada
4
Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
5
Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital & Department of Rheumatology, Odense University Hospital, DK2000 Odense, Denmark
6
NHMRC Clinical Trials Centre, The University of Sydney, Sydney 1450, Australia
7
Department of Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 7RH, UK
8
Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center, University of Freiburg, 79110 Freiburg, Germany
9
European Centre for Disease Prevention and Control, 169 73 Solna, Sweden
10
Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands
11
C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1N 5C8, Canada
12
Centre for Global Health, University of Ottawa, Ottawa, ON K1N 5C8, Canada
13
Division of Infectious Diseases, University of Brescia, 255123 Brescia, Italy
*
Author to whom correspondence should be addressed.
†
UNESCO Chair holder “Training and empowering human resources for health development in resource-limited countries”.
‡
The authors are responsible for the choice and presentation of views contained in this article and for opinions expressed therein, which are not necessarily those of UNESCO and do not commit the Organization.
Int. J. Environ. Res. Public Health 2018, 15(9), 2013; https://doi.org/10.3390/ijerph15092013
Received: 17 July 2018 / Revised: 24 August 2018 / Accepted: 10 September 2018 / Published: 14 September 2018
(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)
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.
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Keywords:
hepatitis C; screening; migrants; viral hepatitis elimination; European Union
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MDPI and ACS Style
Greenaway, C.; Makarenko, I.; Abou Chakra, C.N.; Alabdulkarim, B.; Christensen, R.; Palayew, A.; Tran, A.; Staub, L.; Pareek, M.; Meerpohl, J.J.; Noori, T.; Veldhuijzen, I.; Pottie, K.; Castelli, F.; Morton, R.L. The Effectiveness and Cost-Effectiveness of Hepatitis C Screening for Migrants in the EU/EEA: A Systematic Review. Int. J. Environ. Res. Public Health 2018, 15, 2013.
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