title: Differences in the availability of diagnostics and treatment modalities for chronic hepatitis B across Europe.
abstract: The prevalence and management of chronic hepatitis B virus (HBV) infection differ among European countries. The availability and reimbursement of diagnostics and drugs may also vary, determining distinct treatment outcomes. Herein, we analyse differences in medical facilities for the care of patients with chronic HBV infection across Europe. A survey was sent to the members of the ESCMID Study Group for Viral Hepatitis, all of whom are experts in chronic HBV infection management. The comprehensive survey asked questions regarding hepatitis B surface antigen (HBsAg) prevalence, the availability of diagnostics and drugs marketed, and distinct clinical practice behaviours in the management of chronic HBV infection. World Bank data were used to assess the economic status of the countries. With 16 expert physicians responding (69%), the HBsAg prevalence rates were <1% in France, Hungary, Italy, The Netherlands, Portugal, Spain, and the UK, intermediate (1-5%) in Turkey, Romania, and Serbia, and high (>5%) in Albania and Iran. Regarding the availability and reimbursement of HBV diagnostics (HBV DNA and liver stiffness measurement), HBV drugs (interferon, lamivudine, tenofovir, and entecavir), HBV prophylaxis, and duration of HBeAg-positive and HBeAg-negative HBV infection, the majority of high-income and middle-income countries had no restrictions; Albania, Iran and Serbia had several restrictions in diagnostics and HBV drugs. The countries in the high-income group were also the ones with no restrictions in medical facilities, whereas the upper-middle-income countries had some restrictions. The prevalence of chronic HBV infection is much higher in southern and eastern than in western European countries. Despite the availability of European guidelines, policies for diagnostics and treatment vary significantly across European countries.
authors.affiliation: Infection, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey. Electronic address: rozaras@yahoo.com.
authors.forename: R
authors.initials: R
authors.lastname: Ozaras
authors.affiliation: Infectious Disease Unit, University of Florence School of Medicine, Florence, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Corti
authors.affiliation: Virology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: S
authors.initials: S
authors.lastname: Ruta
authors.affiliation: Infectious Diseases, Université Pierre-et-Marie-Curie and Inserm UMR-S1136, Paris, France.
authors.forename: K
authors.initials: K
authors.lastname: Lacombe
authors.affiliation: Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
authors.forename: M U
authors.initials: MU
authors.lastname: Mondelli
authors.affiliation: NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queen's Medical Centre, Nottingham, UK.
authors.forename: W L
authors.initials: WL
authors.lastname: Irwing
authors.affiliation: Infectious Diseases, AO Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Puoti
authors.affiliation: Department of Internal Medicine, Quaem Hospital, Mashhad University of Medical Science (MUMS), Mashhad, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Khalighi
authors.affiliation: ICU Infectious Disease Unit, Hospital de S. João, Porto, Portugal.
authors.forename: M L
authors.initials: ML
authors.lastname: Santos
authors.affiliation: Infectious Disease Service, University Hospital Center of Tirana, Tirana, Albania.
authors.forename: A
authors.initials: A
authors.lastname: Harxhi
authors.affiliation: Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: I
authors.initials: I
authors.lastname: Lazarevic
authors.affiliation: Infectious Diseases Department, La Paz University Hospital & IdiPAZ, Madrid, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Soriano
authors.affiliation: Sub-Department of Hepato-Pancreatology and Molecular Diagnostic Laboratory, Department of Internal Medicine I, Szent Gyorgy Hospital, Székesfehérvár, Hungary.
authors.forename: J
authors.initials: J
authors.lastname: Gervain
authors.affiliation: Infectious Diseases, Ondokuz Mayis University, Samsun, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Leblebicioglu
authors.affiliation: Internal Medicine and Infectious Diseases, APHP, Paris Descartes University, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Salmon
authors.affiliation: Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
authors.forename: J E
authors.initials: JE
authors.lastname: Arends
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000706:statistics & numerical data; D004363:Drug Utilization; D005060:Europe / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D016036:Seroepidemiologic Studies; D011795:Surveys and Questionnaires
chemical_list: D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens
keywords: Chronic hepatitis B; diagnostic; prevalence; treatment; viral hepatitis