Hepatitis C time trends in reported cases and estimates of the hidden population born before 1965, Denmark and Sweden, 1990 to 2020.

BackgroundAccording to the World Health Organization, hepatitis C virus (HCV) infection should be under control by 2030.AimOur aim was to describe the size and temporal changes in reported cases of chronic HCV infection in Denmark and Sweden and to estimate the size of the hidden (undiagnosed) population born before 1965.MethodsWe extracted all HCV infections reported to national surveillance systems in Denmark and Sweden from 1990 to 2020. Prediction of the size of the hidden HCV-infected population was restricted to the cohort born before 1965 and cases reported up to 2017. We applied a model based on removal sampling from binomial distributions, estimated the yearly probability of diagnosis, and deducted the original HCV-infected population size.ResultsDenmark (clinician-based) reported 10 times fewer hepatitis C cases annually than Sweden (laboratory and clinician-based), peaking in 2007 (n = 425) and 1992 (n = 4,537), respectively. In Denmark, the birth year distribution was monophasic with little change over time. In recent years, Sweden has had a bimodal birth year distribution, suggesting ongoing infection in the young population. In 2017, the total HCV-infected population born before 1965 was estimated at 10,737 living persons (95% confidence interval (CI): 9,744-11,806), including 5,054 undiagnosed, in Denmark and 16,124 (95% CI: 13,639-18,978), including 10,580 undiagnosed, in Sweden.ConclusionsThe reporting of HCV cases in Denmark and Sweden was different. For Denmark, the estimated hidden population was larger than the current national estimate, whereas in Sweden the estimate was in line with the latest published numbers.

The Cost-Effectiveness of a COVID-19 Vaccine in a Danish Context.

BACKGROUND AND OBJECTIVES: Covid-19 vaccines approved by the EU, UK and USA have been found to be safe and effective. The cost effectiveness of these vaccines depends upon a number of factors. The aim of this paper is to explore the cost effectiveness of a COVID-19 vaccine and to analyse how the price of the vaccine and the cost of administrating it influence its cost effectiveness. METHODS: We considered an epidemiological model developed by an expert group within 'Statens Serum Institut', which is a unit under the auspices of the Danish Ministry of Health. The model allowed us to differentiate between two population groups, those aged ≥60 years and those aged <60 years. We used the model to consider four scenarios: (i) vaccination of 25% of the total population (corresponding to approximately 1.5 million persons) but targeting vaccines towards the population aged ≥60 years, (ii) vaccination of 25% of the total population, targeting vaccines only towards the population aged <60 years, (iii) vaccination of 40% of the total population where 15% are aged <60 years and 25% are aged ≥60 years (corresponding approximately to the full Danish population aged >60 years), and (iv) 40% of the total population is vaccinated but vaccines are targeted solely towards those aged <60 years. The time horizon of the analysis was six months, and the perspective was that of the Danish healthcare sector. RESULTS: The results show that inclusion of the elderly population aged ≥60 years was more cost effective than a vaccination strategy that targeted a population aged <60 years old only, when productivity losses were not included. Furthermore, the results show that an extension of the target group from the elderly population only, to also include the younger population comes with an increasing cost per life-year gained. The incremental cost-effectiveness ratio depends on the price of the vaccine, hereunder also the administration costs, and the discount rate used for the estimation of life-years or quality-adjusted life-years gained from a vaccine. Furthermore, inclusion of productivity losses in the analyses influenced the cost effectiveness of vaccination of the population aged <60 years of age. CONCLUSION: The cost effectiveness of a COVID-19 vaccine is sensitive to whether or not productivity losses are included in the analyses. Without productivity losses, the elderly population should always be part of the target group for a COVID-19 vaccination programme. Taking productivity losses into account, at least in the case of low vaccine prices, vaccinating the younger population first can actually be cost effective.