Epidemiology of hepatitis C virus infection in a country with universal access to direct‐acting antiviral agents: Data for designing a cost‐effective elimination policy in Spain

Abstract

Accurate HCV prevalence estimates are necessary for guiding elimination policies. Our aim was to determine the HCV prevalence and assess the cost‐effectiveness of a screen‐and‐treat strategy in the Spanish population. A population‐based, cross‐sectional study (PREVHEP‐ETHON Cohort, Epidemiological sTudy of Hepatic infectiONs; NCT02749864) was performed from July 2015‐April 2017. Participants from three Spanish regions were selected using two‐stage conglomerate sampling, and stratified by age, with randomized subject selection. Anthropometric and demographic data were collected, and blood samples were taken to detect anti‐HCV antibodies/quantify HCV RNA. The cost‐effectiveness of the screening strategies and treatment were analysed using a Markov model. Among 12 246 participants aged 20‐74 (58.4% females), the overall anti‐HCV prevalence was 1.2% (95% CI 1.0‐1.4), whereas the detectable HCV‐RNA prevalence was 0.3% (0.2‐0.4). Infection rates were highest in subjects aged 50‐74 years [anti‐HCV 1.6% (1.3‐1.9), HCV RNA 0.4% (0.3‐0.6]. Among the 147 anti‐HCV + subjects, 38 (25.9%) had active infections while 109 (74.1%) had been cleared of infection; 44 (40.4%) had cleared after antiviral treatment, whereas 65 (59.6%) had cleared spontaneously. Overall, 59.8% of the anti‐HCV + participants were aware of their serological status. Considering a cost of treatment of €7000/patient, implementing screening programmes is cost‐effective across all age cohorts, particularly in patients aged 50‐54 (negative incremental cost‐effectiveness ratio which indicates a cost‐saving strategy). The current HCV burden is lower than previously estimated, with approximately 25% of anti‐HCV + individuals having an active infection. A strategy of screening and treatment at current treatment prices in Spain is cost‐effective across all age cohorts.

Optimization of Hepatitis C Virus Screening Strategies by Birth Cohort in Italy

“…This study has several limitations that could affect the robustness sectional study in Spain found that a stepwise screening strategy, similar to the graduated screening 1 scenario described here, was cost saving, 28 supporting that this type of strategy may be feasible.…”

Bacterial, viral, and fungal infection‐related risk of Parkinson's disease: Meta‐analysis of cohort and case–control studies

“…Considering the high prevalence of these infections, such infection-related increase of risk of PD may affect a quite large population. For example, HCV was reported to affect 0.3% of population in Spain (Crespo et al, 2019), HP colonizes the gastric mucosa of more than half of the global human population (Suwarnalata et al, 2016), Malassezia was identified on more than 80% lesional skin (Arsic Arsenijevic et al, 2014), HBV affects 2 billion people worldwide and over 360 million chronic carriers (Yankam, Anye, Nkfusai, Shirinde, & Cumber, 2019). Therefore, clarification of the effect of such infection on risk of PD may assist the prevention and prediction of PD and bring benefits to a large population.…”

Update on epidemiology of hepatitis B in a low‐endemic European country: There is still much to do

“…The study has some limitations that could involve selection and participation bias that have been previously discussed 6 . We cannot rule out some misclassification in the stage of infection due to the study design.…”

“…We cannot rule out some misclassification in the stage of infection due to the study design. The sample size calculation was based on estimated slightly higher values of the prevalence figures for each age stratum 6 ; therefore, a larger number of subjects were studied, which helps provide a more accurate estimation of the parameters.…”

“…This observational, cross‐sectional, population‐based study on HBV and HCV infections was carried out in Spain between July 2015 and April 2017 (NCT02749864). The design of the study and the results regarding HCV infection have been previously published 6 . The cohort of patients with positive HbsAg was retrospectively analysed to adequately characterize the infection.…”