Open Access Highly Accessed Research article

Infection with hepatitis B and C virus in Europe: a systematic review of prevalence and cost-effectiveness of screening

Susan JM Hahné1*, Irene K Veldhuijzen2, Lucas Wiessing4, Tek-Ang Lim3, Mika Salminen3 and Marita van de Laar3

Author Affiliations

1 Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, Bilthoven, 3720 BA, The Netherlands

2 Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, PO Box 70032, 3000 LP, The Netherlands

3 European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11a, Stockholm, 171 83, Sweden

4 European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Cais do Sodré, Lisbon, 1249-289, Portugal

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BMC Infectious Diseases 2013, 13:181  doi:10.1186/1471-2334-13-181

Published: 18 April 2013



Treatment for chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is improving but not benefiting individuals unaware to be infected. To inform screening policies we assessed (1) the hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus antibody (anti-HCV-Ab) prevalence for 34 European countries; and (2) the cost-effectiveness of screening for chronic HBV and HCV infection.


We searched peer-reviewed literature for data on HBsAg and anti-HCV-Ab prevalence and cost-effectiveness of screening of the general population and five subgroups, and used data for people who inject drugs (PWID) and blood donors from two European organizations. Of 1759 and 468 papers found in the prevalence and cost-effectiveness searches respectively, we included 124 and 29 papers after assessing their quality. We used decision rules to calculate weighted prevalence estimates by country.


The HBsAg and anti-HCV-Ab prevalence in the general population ranged from 0.1%-5.6% and 0.4%-5.2% respectively, by country. For PWID, men who have sex with men and migrants, the prevalence of HBsAg and anti-HCV-Ab was higher than the prevalence in the general population in all but 3 countries. There is evidence that HCV screening of PWID and HBsAg screening of pregnant women and migrants is cost-effective.


The prevalence of chronic HBV and HCV infection varies widely between European countries. Anti-HCV-Ab screening of PWID and HBsAg screening of pregnant women and migrants have European public health priority. Cost-effectiveness analyses may need to take effect of antiviral treatment on preventing HBV and HCV transmission into account.

Hepatitis B virus; Hepatitis C virus; Europe; Prevalence; HBsAg; Anti-HCV-Ab; Cost-effectiveness analyses