The Effectiveness and Cost-Effectiveness of Hepatitis C Screening for Migrants in the EU/EEA: A Systematic Review

Abstract

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.

Hepatitis C screening, diagnosis, and cascade of care among people aged > 40 years in Brasilia, Brazil

“…With the high efficacy of new direct antiviral agents (DAAs), in Brazil, the challenge exists in need to identify and treat infected patients [19]. However, the lack of an efficient cascade of care for chronic HCV infection in Brazil hinders the diagnosis of the disease and access to treatment, which are the most critical factors for eliminating HCV infection and reducing HCV-related mortality [20].…”

Current and forthcoming perspectives in linkage to care of hepatitis C virus infection: Assessment of an Italian focus group

“…Importantly, the screening program can be considered positive as it was accepted by 85% of the subjects, and has the potential to identify a large number of individuals who are HCV positive. In a European wide study, HCV screening was seen as cost effective among migrants living in the EU/EEA (mean 14% of cases and >50% of cases in some countries) [31]. This is relevant since immigrants face many barriers in linkage to care and treatment due to the patient, practitioner, and healthcare system.…”

“…Some of the solutions proposed to overcome these barriers include screening of high-risk children and adults and vaccination of younger children, combined with treatment of infection where possible [32]. However, it is clear that linkage to treatment requires greater attention, and that the goal of HCV elimination will only be possible if healthcare systems effectively include and treat migrants for HCV [31]. In this regard, there is a need for countryspecific strategies and optimized allocation of resources since a substantial proportion of HCV patients remain untreated among migrant populations in Italy and elsewhere in Europe [33].…”

Health of Refugees and Migrants—Where Do We Stand and What Directions Should We Take?

“…These reviews discuss the effectiveness and cost effectiveness of screening for HIV, hepatitis B and C, schistosomiasis, and strongyloidiasis. The articles also discuss the effectiveness of interventions (including vaccinations) and their cost effectiveness in migrants in the EU/EEA (Table 1) [9,10,11,12,15,16]. These have led to a recent publication of the European Center for Disease Prevention and Control (ECDC) entitled “Public health guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/European Economic Area (EEA)” [46].…”