All-oral direct-acting antiviral drugs (DAAs) for hepatitis C virus, which have response rates of 95% or more, represent a major clinical advance. However, the high list price of DAAs has led many governments to restrict their reimbursement. We reviewed the availability of, and national criteria for, interferon-free DAA reimbursement among countries in the European Union and European Economic Area, and Switzerland. Reimbursement documentation was reviewed between Nov 18, 2016, and Aug 1, 2017. Primary outcomes were fibrosis stage, drug or alcohol use, prescriber type, and HIV co-infection restrictions. Among the 35 European countries and jurisdictions included, the most commonly reimbursed DAA was ombitasvir, paritaprevir, and ritonavir, with dasabuvir, and with or without ribavirin (33 [94%] countries and jurisdictions). 16 (46%) countries and jurisdictions required patients to have fibrosis at stage F2 or higher, 29 (83%) had no listed restrictions based on drug or alcohol use, 33 (94%) required a specialist prescriber, and 34 (97%) had no additional restrictions for people co-infected with HIV and hepatitis C virus. These findings have implications for meeting WHO targets, with evidence of some countries not following the 2016 hepatitis C virus treatment guidelines by the European Association for the Study of Liver.

1st Department of Internal Medicine University Hospital University of Pavol Jozef Safarik Kosice Slovakia

Abdominal Center Helsinki University Hospital Helsinki University Helsinki Finland

Addiction and Dual Diagnosis Unit Psychiatric Department Hospital Universitario Vall d'Hebron Universidad Autónoma de Barcelona Barcelona Spain

Arud Centres for Addiction Medicine Zürich Switzerland

Barcelona Institute for Global Health Hospital Clínic Univeristy of Barcelona Barcelona Spain; CHIP Rigshospitalet University of Copenhagen Copenhagen Denmark

Centre of Infectious Diseases Vilnius University Hospital Santaros Klinikos Vilnius University Vilnius Lithuania

Clinic for Infectious Diseases and Febrile Illnesses University Medical Centre Ljubljana Slovenia

Department of Biomedical Sciences and Humanitas Clinical and Research Center Humanitas University Milan Italy

Department of Gastroenterology and Hepatology Hospital Santa Maria Medical School Lisbon University of Lisbon Lisbon Portugal

Department of Gastroenterology and Hepatology Ziekenhuis Oost Limburg Genk Belgium; Department of Medicine and Life Sciences University of Hasselt Hasselt Belgium; Department of Hepatology UZ Leuven Leuven Belgium

Department of Gastroenterology Hepato Pancreato Biliary Surgery and Transplantology Military Medical Academy Sofia Bulgaria

Department of Hepatogastroenterology Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Hepatology Infectology Center of Latvia Riga East University Hospital Riga Latvia; Faculty of Medicine University of Latvia Riga Latvia

Department of Infection and Immunity Luxembourg Institute of Health Luxembourg City Luxembourg

Department of Infectious Diseases Academic Medical Center Amsterdam Netherlands

Department of Infectious Diseases Akershus University Hospital University of Oslo Oslo Norway

Department of Infectious Diseases and Hepatology Medical University of Bialystok Bialystok Poland

Department of Infectious Diseases Karolinska University Hospital Stockholm Sweden

Department of Infectious Diseases Odense University Hospital University of Southern Denmark Odense Denmark

Department of Internal Medicine Aristotle University of Thessaloniki Thessaloniki Greece

Department of Internal Medicine University of Tartu Estonia

Division of Gastroenterology Department of Medicine Landspitali University Hospital Reykjavik Iceland

Gastroenterology and Hepatology Fundeni Clinical Institute Bucharest Romania

Gastroenterology Department Mater Dei Hospital Msida Malta

Health Protection Scotland Glasgow UK

Hepatology Center St István and St László Hospital Budapest Hungary

Hopital Henri Mondor Universite Paris Est Créteil France

INHSU Madrid Spain

Ludwig Maximilians University Munich Germany

Ministry of Health Luxembourg City Luxembourg

National Hepatitis C Treatment Programme Health Service Executive Dr Steevens' Hospital Dublin Ireland

Office of Public Health Vaduz Liechtenstein

Queen Mary University of London London UK

Social Medicine University of Bristol Bristol UK

The Kirby Institute UNSW Sydney NSW Australia

University Hospital for Infectious Diseases University of Zagreb Zagreb Croatia

University of Cyprus Nicosia Cyprus

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