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Title: | 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 | Authors: | Razavi, Homie Robbins, Sarah Zeuzem, Stefan Negro, Francesco Buti, Maria Duberg, Ann-Sofi Roudot-Thoraval, Francoise Craxi, Antonio Manns, Michael Marinho, Rui T. Hunyady, Bela Colombo, Massimo Aleman, Soo Antonov, Krasimir Arkkila, Perttu Athanasakis, Kostas 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, Chris Falconer, Karolin Farkkila, Martti Flisiak, Robert Frankova, Sona Gamkrelidze, Ivane Garcia-Samaniego, Javier Genov, Jordan Gerstoft, Jan Gheorghe, Liana Goldis, Adrian Gountas, Ilias Gregorcic, Sergeja Gschwantler, Michael Gunter, Jessie Halota, Waldemar Harcouet, Laura Hezode, Christophe Hoffmann, Patrick Horvath, Gabor Hrstic, Irena Jarcuska, Peter Jelev, Deian Jeruma, Agita Kaberg, Martin Kieran, Jennifer Kondili, Loreta A. Kotzev, Iskren Krarup, Henrik Kristian, Pavol Lagging, Martin Laleman, Wim Lazaro, Pablo Liakina, Valentina Luksic, Boris Maimets, Matti Makara, Mihaly 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 Ovrehus, 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. Schreter, Ivan Seguin-Devaux, Carole Simojoki, Kaarlo Simonova, Marietta Smit, Peter J. Souliotis, Kyriakos Speiciene, Danute Sperl, Jan Starkel, Peter Struck, Daniel Sypsa, Vana Thornton, Lelia Tolmane, Ieva Tomasiewicz, Krzysztof Valantinas, Jonas Van Damme, Pierre de Vijver, David van van der Meer, Adriaan J. van Santen, Daniela Van Vlierberghe, Hans VANDIJCK, Dominique Vella, Stefano Videcnik-Zorman, Jerneja Vogel, Wolfgang Weis, Nina Hatzakis, Angelos |
Issue Date: | 2017 | Publisher: | ELSEVIER INC | Source: | LANCET GASTROENTEROLOGY & HEPATOLOGY, 2(5), p. 325-336 | 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 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. | Notes: | [Razavi, Homie; Robbins, Sarah; Blach, Sarah; Estes, Chris; Gamkrelidze, Ivane; Gountas, Ilias; Gunter, Jessie; Murphy, Kimberly; Nde, Helen; Pasini, Ken; Razavi-Shearer, Devin; Razavi-Shearer, Kathryn; Schmelzer, Jonathan D.] Ctr Dis Anal, Lafayette, CO 80026 USA. [Zeuzem, Stefan] Johann Wolfgang Goethe Univ Hosp, Dept Med, Frankfurt, Germany. [Negro, Francesco] Univ Hosp, Div Gastroenterol & Hepatol, Geneva, Switzerland. [Negro, Francesco] Univ Hosp, Div Clin Pathol, Geneva, Switzerland. [Buti, Maria] Hosp Valle De Hebron, CIBERehd, Barcelona, Spain. [Duberg, Ann-Sofi] Orebro Univ, Fac Med & Hlth, Dept Infect Dis, Orebro, Sweden. [Duberg, Ann-Sofi] Orebro Univ, Sch Hlth & Med Sci, Orebro, Sweden. [Roudot-Thoraval, Francoise] Hop Henri Mondor, Dept Sante Publ, Creteil, France. [Craxi, Antonio] Univ Palermo, Dept Internal Med & Med Special, Gastroenterol & Hepatol, Palermo, Italy. [Craxi, Antonio] Azienda Osped Univ Policlin, Gastroenterol & Epatol, Palermo, Italy. [Manns, Michael] Hannover Med Sch, Dept Gastroenterol Hepatol & Endocrinol, Hannover, Germany. [Manns, Michael] German Ctr Infect Res, Partner Site Hannover Braunschweig, Hannover, Germany. [Marinho, Rui T.] Univ Lisbon, Hosp Santa Maria, Ctr Hosp Lisboa Norte, Dept Gastroenterol, Lisbon, Portugal. [Hunyady, Bela] Somogy Cty Kaposi Mor Teaching Hosp, Dept Gastroenterol, Kaposvar, Hungary. [Hunyady, Bela] Univ Pecs, Dept Med 1, Kaposvar, Hungary. [Colombo, Massimo] Univ Milan, Dept Gastroenterol, Milan, Italy. [Aleman, Soo] Karolinska Inst, Dept Med Huddinge, Stockholm, Sweden. [Aleman, Soo] Karolinska Univ Hosp, Dept Gastroenterol & Hepatol, Stockholm, Sweden. [Aleman, Soo] Karolinska Univ Hosp, Dept Infect Dis, Stockholm, Sweden. [Antonov, Krasimir; Jelev, Deian; Mateva, Lyudmila] Univ Hosp St Ivan Rilski, Sofia, Bulgaria. [Arkkila, Perttu] Univ Helsinki, Cent Hosp, Dept Gastroenterol, Helsinki, Finland. [Athanasakis, Kostas] Natl Sch Publ Hlth, Dept Hlth Econ, Athens, Greece. [Blachier, Martin] Publ Hlth Expertise, Paris, France. [Calinas, Filipe] Ctr Hosp Lisboa Cent, Hosp Santo Antonio Capuchos, Dept Gastroenterol, Lisbon, Portugal. [Calleja, Jose L.] Hosp Puerta de Hierro, Madrid, Spain. [Christensen, Peer B.; Ovrehus, Anne L. H.] Odense Univ Hosp, Dept Infect Dis, Odense, Denmark. [Cramp, Matthew E.] Plymouth Univ, Peninsula Sch Med, Plymouth, Devon, England. [Cramp, Matthew E.] Plymouth Univ, Peninsula Sch Dent, Plymouth, Devon, England. [Croes, Esther] Trimbos Inst, Utrecht, Netherlands. [de Knegt, Robert J.; van der Meer, Adriaan J.] Erasmus Univ, Med Ctr, Dept Gastroenterol & Hepatol, Rotterdam, Netherlands. [de Ledinghen, Victor] Ctr Hosp Univ Bordeaux, Hop Haut Leveque, Serv Hepatogastroenterol, Pessac, France. [de Ledinghen, Victor] Univ Bordeaux Segalen, INSERM, U1053, Pessac, France. [Delile, Jean-Michel; de Vijver, David van] Univ Med Ctr Groningen, Groningen, Netherlands. [Falconer, Karolin; Kaberg, Martin] Karolinska Inst, Karolinska Univ Hosp, Dept Med Huddinge, Infect Dis Unit, Stockholm, Sweden. [Farkkila, Martti] Univ Helsinki, Cent Hosp, Dept Gastroenterol, Helsinki, Finland. [Flisiak, Robert] Med Univ Bialystok, Dept Infect Dis & Hepatol, Bialystok, Poland. [Frankova, Sona; Sperl, Jan] Inst Clin & Expt Med, Dept Hepatogastroenterol, Prague, Czech Republic. [Garcia-Samaniego, Javier] Hosp Univ La Paz, CIBERehd, IdiPAZ, Madrid, Spain. [Genov, Jordan; Mitova, Rumiana] Univ Hosp Queen Joanna, Sofia, Bulgaria. [Weis, Nina] Univ Copenhagen, Dept Clin Med, Copenhagen, Denmark. [Gerstoft, Jan] Univ Copenhagen, Rigshosp, Dept Infect Dis, Ctr Hlth & Infect Dis Res, Copenhagen, Denmark. [Gheorghe, Liana] Fundeni Clin Inst, Ctr Gastroenterol & Hepatol, Bucharest, Romania. [Goldis, Adrian] Univ Med Victor Babes, Gastroenterol Clin, Timisoara, Romania. 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[Kondili, Loreta A.] Ist Super Sanita, Therapeut Res & Med Evaluat Dept, Rome, Italy. [Kotzev, Iskren] Univ Hosp St Marina, Varna, Bulgaria. [Krarup, Henrik] Aalborg Univ Hosp, Dept Med Gastroenterol, Aalborg, Denmark. [Krarup, Henrik] Aalborg Univ Hosp, Sect Mol Diagnost, Cin Biochem, Aalborg, Denmark. [Kristian, Pavol; Schreter, Ivan] Pavol Jozef Safarik Univ, Fac Med, Dept Infectol & Travel Med, Kosice, Slovakia. [Lagging, Martin] Univ Gothenburg, Sahlgrenska Acad, Inst Biomed, Dept Infect Med, Gothenburg, Sweden. [Lagging, Martin] Univ Gothenburg, Sahlgrenska Acad, Inst Biomed, Dept Virol, Gothenburg, Sweden. [Laleman, Wim] Katholieke Univ Leuven, Univ Hosp Leuven, Leuven, Belgium. [Laleman, Wim] Jessa Hosp, Hasselt, Belgium. [Liakina, Valentina; Speiciene, Danute; Valantinas, Jonas] Vilnius Univ, Fac Med, Ctr Hepatol Gastroenterol & Dietet, Vilnius, Lithuania. [Liakina, Valentina] Vilnius Gediminas Tech Univ, Dept Biomech, Vilnius, Lithuania. [Luksic, Boris] Split Univ Hosp, Clin Dept Infect Dis, Split, Croatia. [Luksic, Boris] Split Univ, Sch Med, Split, Croatia. [Maimets, Matti; Salupere, Riina] Univ Tartu, Tartu Univ Hosp, Tartu, Estonia. [Makara, Mihaly] St Laszlo Hosp, Cent Outpatient Clin, Budapest, Hungary. [Mennini, Francesco S.] Ctr Econ Evaluat & Hlth Technol Assessment, Rome, Italy. [Mennini, Francesco S.] Univ Roma Tor Vergata, Rome, Italy. [Moreno, Christophe] Univ Libre Bruxelles, Hop Erasme, Clin Univ Bruxelles, Brussels, Belgium. [Mossong, Joel] Lab Natl Sante, Dudelange, Luxembourg. [Nemecek, Vratislav] Natl Inst Publ Hlth, Natl Reference Lab Hepatitis, Prague, Czech Republic. [Nonkovic, Dijana] Inst Publ Hlth Cty Dalmatia, Dept Epidemiol, Dalmatia, Croatia. [Norris, Suzanne] Trinity Coll Dublin, Dublin, Ireland. [Oltman, Marian] Gastroenterol & Hepatol Ctr, Bratislava, Slovakia. [Papatheodoridis, George] Univ Athens, Laiko Gen Hosp, Med Sch Natl & Kapodistrian, Dept Gastroenterol, Athens, Greece. [Reesink, Henk W.] Acad Med Ctr, Dept Hepatol, Amsterdam, Netherlands. [Reic, Tatjana] European Liver Patients Assoc, St Truiden, Belgium. [Rozentale, Baiba] Infectol Ctr Latvia, Dept Hepatol, Riga, Latvia. [Rozentale, Baiba] Riga Stradins Univ, Dept Infectol & Dermatol, Riga, Latvia. [Ryder, Stephen D.] Nottingham Univ Hosp Natl Hlth Serv Trust, Nottingham Digest Dis Ctr, Nottingham, England. [Ryder, Stephen D.] Nottingham Univ Hosp Natl Hlth Serv Trust, Natl Inst Hlth Res, Biomed Res Unit, Nottingham, England. [Ryder, Stephen D.] Univ Nottingham, Nottingham, England. [Sarmento-Castro, Rui] Ctr Hosp Porto, Dept Infect Dis, Porto, Portugal. [Sarrazin, Christoph] Johann Wolfgang Goethe Univ Hosp, Frankfurt, Germany. [Sarrazin, Christoph] St Josefs Hosp, Med Dept 2, Gastroenterol, Hepatol,Infectiol, Wiesbaden, Germany. [Seguin-Devaux, Carole] Luxembourg Inst Hlth, Dept Infect & Immun, Esch Sur Alzette, Luxembourg. [Simojoki, Kaarlo] A Clin Fdn, Helsinki, Finland. [Simonova, Marietta] Mil Med Acad, Sofia, Bulgaria. [Smit, Peter J.] Hiv Vereniging, Amsterdam, Netherlands. [Souliotis, Kyriakos] Univ Peloponnese, Fac Social & Polit Sci, Corinth, Greece. [Souliotis, Kyriakos] Ctr Hlth Serv, Athens, Greece. [Starkel, Peter] Catholic Univ Louvain, Clin Univ St Luc, Brussels, Belgium. [Struck, Daniel] Luxembourg Inst Hlth, Dept Populat Hlth, Strassen, Luxembourg. [Sypsa, Vana; Hatzakis, Angelos] Univ Athens, Sch Med, Dept Hyg Epidemiol & Med Stat, Athens, Greece. [Thornton, Lelia] Hlth Protect Surveillance Ctr, Dublin, Ireland. [Tolmane, Ieva] Riga East Univ Hosp, Infectol Ctr Latvia, Dept Hepatol, Riga, Latvia. [Tolmane, Ieva] Latvian Univ, Dept Med, Riga, Latvia. [Tomasiewicz, Krzysztof] Med Univ Lublin, Dept Infect Dis, Lublin, Poland. [Van Damme, Pierre; Van Vlierberghe, Hans] Univ Antwerp, Antwerp, Belgium. [van Santen, Daniela] Publ Hlth Serv Amsterdam, Dept Res, Infect Dis Cluster, Amsterdam, Netherlands. [Vandijck, Dominique] Univ Ghent, Dept Publ Hlth, Ghent, Belgium. [Vandijck, Dominique] Hasselt Univ, Dept Hlth Econ & Patient Safety, Diepenbeek, Belgium. [Vella, Stefano] Ist Super Sanita, Rome, Italy. [Vogel, Wolfgang] Med Univ Innsbruck, Dept Internal Med, Div Gastroenterol & Hepatol, Innsbruck, Austria. [Weis, Nina] Copenhagen Univ Hosp, Dept Infect Dis, Hvidovre, Denmark. [Hatzakis, Angelos] Hellen Sci Soc Study AIDS & Sexually Transmitted, Athens, Greece. | Document URI: | http://hdl.handle.net/1942/28600 | e-ISSN: | 2468-1253 | DOI: | 10.1016/S2468-1253(17)30045-6 | ISI #: | 000426980800014 | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2019 |
Appears in Collections: | Research publications |
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