Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2 Canada.
Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2.
Int J Environ Res Public Health. 2018 Sep 14;15(9):2013. doi: 10.3390/ijerph15092013.
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.
慢性丙型肝炎（HCV）是欧盟/欧洲经济区（EU/EEA）的公共卫生重点，也是慢性肝病和肝癌的主要原因。移民在欧盟/欧洲经济区（EU/EEA）的 HCV 病例中占不成比例的数量（平均占病例的 14%，在某些国家超过 50%）。我们进行了两项系统评价（SR），以评估 HCV 对居住在欧盟/欧洲经济区（EU/EEA）的移民进行筛查的效果和成本效益。我们发现，HCV 筛查检测具有高度的敏感性和特异性。临床试验报告称，直接作用抗病毒（DAA）疗法在广泛的人群中耐受性良好，几乎治愈所有病例（>95%），并将肝癌的发展风险降低 85%，全因死亡率降低 80%。根据 2015 年的成本，基于 DAA 的方案仅具有适度的成本效益，因此，2015 年欧盟/欧洲经济区只有不到 30%的 HCV 患者接受了筛查，不到 5%的 HCV 病例接受了治疗。由于存在一些患者、医生和卫生系统方面的障碍，移民在与护理和治疗联系方面面临额外的障碍。尽管 HCV 成本的降低使欧盟/欧洲经济区的治疗更加普及，但如果卫生系统包括并治疗 HCV 移民，该地区才有可能消除 HCV。
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