@article{3126194,
    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",
    author = "Razavi, H. and Robbins, S. and Zeuzem, S. and Negro, F. and Buti, M. and Duberg, A. and Roudot-Thoraval, F. and Craxi, A. and Manns, M. and Marinho, R.T. and Hunyady, B. and Colombo, M. and Aleman, S. and Antonov, K. and Arkkila, P. and Athanasakis, K. and Blach, S. and Blachier, M. and Blasco, A.J. and Calinas, F. and Calleja, J.L. and Christensen, P.B. and Cramp, M.E. and Croes, E. and de Knegt, R.J. and de Ledinghen, V. and Delile, J.-M. and Estes, C. and Falconer, K. and Färkkilä, M. and Flisiak, R. and Frankova, S. and Gamkrelidze, I. and García-Samaniego, J. and Genov, J. and Gerstoft, J. and Gheorghe, L. and Goldis, A. and Gountas, I. and Gregorčič, S. and Gschwantler, M. and Gunter, J. and Halota, W. and Harcouet, L. and Hézode, C. and Hoffmann, P. and Horvath, G. and Hrstic, I. and Jarčuška, P. and Jelev, D. and Jeruma, A. and Kåberg, M. and Kieran, J. and Kondili, L.A. and Kotzev, I. and Krarup, H. and Kristian, P. and Lagging, M. and Laleman, W. and Lázaro, P. and Liakina, V. and Lukšić, B. and Maimets, M. and Makara, M. and Mateva, L. and Maticic, M. and Mennini, F.S. and Mitova, R. and Moreno, C. and Mossong, J. and Murphy, K. and Nde, H. and Nemecek, V. and Nonkovic, D. and Norris, S. and Oltman, M. and Øvrehus, A.L.H. and Papatheodoridis, G. and Pasini, K. and Razavi-Shearer, D. and Razavi-Shearer, K. and Reesink, H.W. and Reic, T. and Rozentale, B. and Ryder, S.D. and Salupere, R. and Sarmento-Castro, R. and Sarrazin, C. and Schmelzer, J.D. and Schréter, I. and Seguin-Devaux, C. and Simojoki, K. and Simonova, M. and Smit, P.J. and Souliotis, K. and Speiciene, D. and Sperl, J. and Stärkel, P. and Struck, D. and Sypsa, V. and Thornton, L. and Tolmane, I. and Tomasiewicz, K. and Valantinas, J. and Van Damme, P. and van de Vijver, D. and van der Meer, A.J. and van Santen, D. and Van Vlierberghe, H. and Vandijck, D. and Vella, S. and Videčnik-Zorman, J. and Vogel, W. and Weis, N. and Hatzakis, A. and The European Union HCV Collaborators",
    journal = "The Lancet Gastroenterology and Hepatology",
    year = "2017",
    volume = "2",
    number = "5",
    pages = "325-336",
    publisher = "Elsevier Ireland Ltd",
    doi = "10.1016/S2468-1253(17)30045-6",
    keywords = "antiviral therapy;  Article;  Delphi study;  European Union;  geographic distribution;  hepatitis C;  human;  immigrant;  immigration;  liver cell carcinoma;  liver cirrhosis;  liver fibrosis;  mass screening;  model;  morbidity;  mortality;  practice guideline;  prevalence;  priority journal;  sustained virologic response;  viral clearance;  viremia;  virus transmission;  world health organization;  cost of illness;  disease eradication;  hepatitis C;  Markov chain;  migration;  prevalence;  statistics and numerical data;  viremia, antivirus agent, Antiviral Agents;  Cost of Illness;  Disease Eradication;  Emigration and Immigration;  European Union;  Hepatitis C;  Humans;  Markov Chains;  Prevalence;  Viremia;  World Health Organization",
    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. Funding Gilead Sciences. © 2017 Elsevier Ltd"
}