Email updates

Keep up to date with the latest news and content from BMC Public Health and BioMed Central.

Open Access Highly Accessed Research article

HCV-related burden of disease in Europe: a systematic assessment of incidence, prevalence, morbidity, and mortality

Nikolai Mühlberger1, Ruth Schwarzer1, Beate Lettmeier1, Gaby Sroczynski1, Stefan Zeuzem2 and Uwe Siebert134*

Author Affiliations

1 Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Information Systems and Health Technology Assessment, UMIT - University of Health Sciences, Medical Informatics and Technology, Hall i.T, Austria

2 Department of Internal Medicine, Gastroenterology, Hepatology, Pneumology and Endocrinology, Johann Wolfgang Goethe-University, Frankfurt a.M, Germany

3 Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

4 Program in Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA

For all author emails, please log on.

BMC Public Health 2009, 9:34  doi:10.1186/1471-2458-9-34

Published: 22 January 2009

Abstract

Background

Hepatitis C virus (HCV) is a leading cause of chronic liver disease, end-stage cirrhosis, and liver cancer, but little is known about the burden of disease caused by the virus. We summarised burden of disease data presently available for Europe, compared the data to current expert estimates, and identified areas in which better data are needed.

Methods

Literature and international health databases were systematically searched for HCV-specific burden of disease data, including incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and liver transplantation. Data were collected for the WHO European region with emphasis on 22 countries. If HCV-specific data were unavailable, these were calculated via HCV-attributable fractions.

Results

HCV-specific burden of disease data for Europe are scarce. Incidence data provided by national surveillance are not fully comparable and need to be standardised. HCV prevalence data are often inconclusive. According to available data, an estimated 7.3–8.8 million people (1.1–1.3%) are infected in our 22 focus countries. HCV-specific mortality, DALY, and transplantation data are unavailable. Estimations via HCV-attributable fractions indicate that HCV caused more than 86000 deaths and 1.2 million DALYs in the WHO European region in 2002. Most of the DALYs (95%) were accumulated by patients in preventable disease stages. About one-quarter of the liver transplants performed in 25 European countries in 2004 were attributable to HCV.

Conclusion

Our results indicate that hepatitis C is a major health problem and highlight the importance of timely antiviral treatment. However, data on the burden of disease of hepatitis C in Europe are scarce, outdated or inconclusive, which indicates that hepatitis C is still a neglected disease in many countries. What is needed are public awareness, co-ordinated action plans, and better data. European physicians should be aware that many infections are still undetected, provide timely testing and antiviral treatment, and avoid iatrogenic transmission.