Review for 10.1186/1471-230X-13-16 (2013)

Reviewer's report
Title:The Burden of Hepatitis C in Europe from the Patients' Perspective: a
survey in 5 countries
Version: 2Date:24 November 2012
Reviewer: Maria Stepanova
Reviewer's report:
General comments:
The paper by Vietri et al. describes the estimate of the economic burden of HCV
infection in Europe. While this estimate is well studied in the U.S., in Europe it is
less appreciated and mostly likely varies significantly between countries. The
introduction is very well written, the background for the study is clearly described,
and so is the motivation and the aim. The Methods are also well described and
clear with sufficient references justifying the choice of the approaches employed.
Results present the data sufficient to support the conclusions made. I found it
interesting that less than half of HCV-infected participants report being employed.
Of surprising findings, I see that treatment-naive patients comprise approximately
half of the HCV-infected cohort. Does this mean that half of HCV-infected
individuals reported receiving treatment? As a fellow American, I find it is very
unusual, so I'd like to know how the treatment-naive patients were identified
(which questionnaire, how many replies, which proportion of those who replied
reported having received treatment). Also, for those who received treatment, how
their treatment outcome was incorporated to the study?
To major limitations of the study, the presence of HCV infection was ascertained
based on self-reports. The authors claim that it unlikely influences the outcome
while I cannot agree with that. Recent U.S. data suggests that at least half of the
HCV-infected adults are unaware of their infection, and, more important, those
who are aware are different from those who are not (Denniston MM et al,
Hepatology 2012): the cohort that is not aware of their infection is predominantly
male, has lower income and is generally more socially challenged. Thus, it is
difficult to estimate how such bias would affect the results, but it most certainly
would.
No major revisions suggested. Minor comments:
p.3. "HCV was estimated to have caused more than 86,000 deaths in Europe in
2002". Sounds a bit outdated in late 2012. Are there any newer sources of such
data? There are two opposite trends happening at the same time right now -
ageing of the infected population and a bloom of treatment options for both HCV
infection and end-stage liver disease, so the superposition is not obvious but
interesting to know. In the U.S., the former outweighs substantially, while in
Europe, it may be different due to different healthcare system leading to different
treatment access.
p.3. "six months following treatment." A better way to say this is "six months after
the end of treatment." since treatment typically takes many months.
p.3 & 8. The authors use "U.S. arm" and "European wave" terms. Are arm and
wave different? If so, how? If not, please use consistent terminology.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests