title: Infection with hepatitis B and C virus in Europe: a systematic review of prevalence and cost-effectiveness of screening.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, Bilthoven, 3720 BA, The Netherlands. Susan.Hahne@rivm.nl
authors.forename: Susan J M
authors.initials: SJ
authors.lastname: Hahné
authors.forename: Irene K
authors.initials: IK
authors.lastname: Veldhuijzen
authors.forename: Lucas
authors.initials: L
authors.lastname: Wiessing
authors.forename: Tek-Ang
authors.initials: TA
authors.lastname: Lim
authors.forename: Mika
authors.initials: M
authors.lastname: Salminen
authors.forename: Marita van de
authors.initials: Mv
authors.lastname: Laar
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005060:Europe / Q000453:epidemiology; D005260:Female; D006509:Hepatitis B / Q000191:economics / Q000453:epidemiology*; D006526:Hepatitis C / Q000191:economics / Q000453:epidemiology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015995:Prevalence; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D014171:Transients and Migrants / Q000706:statistics & numerical data