Barriers to care and treatment for patients with chronic viral hepatitis in Europe: a systematic review

TY - JOUR

T1 - Barriers to care and treatment for patients with chronic viral hepatitis in Europe: a systematic review

AU - Papatheodoridis, George V

AU - Tsochatzis, Emmanuel

AU - Hardtke, Svenja

AU - Wedemeyer, Heiner

N1 - © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

PY - 2014/11

Y1 - 2014/11

N2 - BACKGROUND & AIMS: Despite the availability of effective therapies for hepatitis B (HBV) and C virus (HCV), only a minority of these patients receive treatment. We systematically reviewed published data on barriers to management for chronic HBV/HCV patients in Europe.METHODS: Literature search to identify studies including adult patients with chronic HBV/HCV infection from European countries and data on barriers to treatment.RESULTS: Twenty-five studies including 6253 chronic HBV and 19,014 HCV patients were identified, of which only two were from Eastern Europe. The mean rate of no treatment in HBV patients was 42% being higher in North-Western European countries than Italy (56% vs. 39%, P < 0.001). Immigrants represented the most common barrier to HBV treatment. The mean rate of no treatment in HCV RNA-positive patients was 57%, being highest in Romania (89%), intermediate in France (79%) and lower though still high in other European countries (52%, P < 0.001). The predominant barriers to HCV treatment were lack of financial resources in Romania and direct/indirect limitations of interferon-alfa and/or parenteral drug and alcohol abuse in other countries. The mean rate of no treatment was highest in HCV RNA-positive parenteral drug users (72%) and intermediate in those with HCV-HIV co-infection (64%).CONCLUSIONS: A substantial proportion of diagnosed chronic HBV and the majority of diagnosed HCV patients remain untreated. The rates and most importantly the reasons of barriers to treatment in chronic HBV/HCV patients vary widely among European countries supporting the need for country-specific national strategies, resource allocation and implementation of global management policies.

AB - BACKGROUND & AIMS: Despite the availability of effective therapies for hepatitis B (HBV) and C virus (HCV), only a minority of these patients receive treatment. We systematically reviewed published data on barriers to management for chronic HBV/HCV patients in Europe.METHODS: Literature search to identify studies including adult patients with chronic HBV/HCV infection from European countries and data on barriers to treatment.RESULTS: Twenty-five studies including 6253 chronic HBV and 19,014 HCV patients were identified, of which only two were from Eastern Europe. The mean rate of no treatment in HBV patients was 42% being higher in North-Western European countries than Italy (56% vs. 39%, P < 0.001). Immigrants represented the most common barrier to HBV treatment. The mean rate of no treatment in HCV RNA-positive patients was 57%, being highest in Romania (89%), intermediate in France (79%) and lower though still high in other European countries (52%, P < 0.001). The predominant barriers to HCV treatment were lack of financial resources in Romania and direct/indirect limitations of interferon-alfa and/or parenteral drug and alcohol abuse in other countries. The mean rate of no treatment was highest in HCV RNA-positive parenteral drug users (72%) and intermediate in those with HCV-HIV co-infection (64%).CONCLUSIONS: A substantial proportion of diagnosed chronic HBV and the majority of diagnosed HCV patients remain untreated. The rates and most importantly the reasons of barriers to treatment in chronic HBV/HCV patients vary widely among European countries supporting the need for country-specific national strategies, resource allocation and implementation of global management policies.

KW - Adult

KW - Emigrants and Immigrants/statistics & numerical data

KW - Europe/epidemiology

KW - Health Services Accessibility/economics

KW - Hepatitis B, Chronic/epidemiology

KW - Hepatitis C, Chronic/epidemiology

KW - Humans

U2 - 10.1111/liv.12565

DO - 10.1111/liv.12565

M3 - SCORING: Review article

C2 - 24750532

VL - 34

SP - 1452

EP - 1463

JO - LIVER INT

JF - LIVER INT

SN - 1478-3223

IS - 10

ER -