title: Is elimination of HCV possible in a country with low diagnostic rate and moderate HCV prevalence?: The case of Greece.
abstract: OBJECTIVE
  The treatment of hepatitis C (HCV) with interferon (IFN)-free direct-acting antivirals (DAAs) is anticipated to change the future burden of disease. The aim of this study is to quantify the impact of IFN-free DAAs on HCV-related morbidity and mortality in Greece under different scenarios concerning treatment coverage and primary prevention, including the proposed by World Health Organization Global Hepatitis Strategy.
  
  
  METHODS
  A previously described model was used to project the future disease burden up to 2030 under scenarios, which includes treatment based on the combination of pegylated-IFN with ribavirin (base case) and scenarios using DAAs therapies.
  
  
  RESULTS
  Under the base case scenario, an increase in HCV-related morbidity and mortality is predicted in Greece (mortality in 2030: +23.6% compared with 2015). If DAAs are used with the same treatment coverage, the number of hepatocellular carcinoma cases and of liver related deaths are predicted to be lower by 4-7% compared with 2015. Under increased treatment coverage (from 2000 treated/year to approximately 5000/year in 2015-2020 and 2500/year subsequently), morbidity and mortality will decrease by 43-53% in 2030 compared with 2015. To achieve the WHO Global Hepatitis Strategy goals, a total number of 86 500 chronic hepatitis C patients will have to be treated during 2015-2030.
  
  
  CONCLUSIONS
  Elimination of HCV in Greece by 2030 necessitates great improvements in primary prevention, implementation of large screening programs and high treatment coverage.
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Ilias
authors.initials: I
authors.lastname: Gountas
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Vana
authors.initials: V
authors.lastname: Sypsa
authors.affiliation: Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Papatheodoridis
authors.affiliation: Faculty of Social and Political Sciences, University of Peloponnese, Korinthos, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Souliotis
authors.affiliation: Center for Disease Analysis, Lafayette, Colorado, USA.
authors.forename: Homie
authors.initials: H
authors.lastname: Razavi
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Angelos
authors.initials: A
authors.lastname: Hatzakis
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage*; D060740:Disease Eradication; D004359:Drug Therapy, Combination; D006115:Greece / Q000453:epidemiology; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage; D008403:Mass Screening; D009017:Morbidity; D011092:Polyethylene Glycols / Q000008:administration & dosage; D015995:Prevalence; D011994:Recombinant Proteins / Q000008:administration & dosage; D012254:Ribavirin / Q000008:administration & dosage*; D013997:Time Factors; D014944:World Health Organization
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a
keywords: Greece; disease burden; elimination; hepatitis C; modeling; projections