Page 27 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS
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Inventory of current EU paediatric vision and hearing screening programmes
INTRODUCTION
Childhood sensory functions play a key role in intellectual and social development. Vision or hearing impairment affects both personal and societal health of children. Earlier detection of visual or hearing deficits improve outcome.1-4 Vision and hearing screening programmes are based on the same general principles, but vary both within and across European Union (EU) countries, regarding tests used, age of testing, frequency of testing, professions involved in screening, referral procedure, funding and coverage. Such differences can result in health inequities. No screening, or screening with little population coverage, can result in delayed provision of the correct treatment and increased disease burden. Excessive screening can result in inappropriate interventions and increased costs for health care systems.
Vision screening and subsequent treatment has reduced the occurrence of insufficiently detected and treated amblyopia.5 In the Netherlands, amblyopia is now detected more than two years earlier than in the 1970s.6 Early screening and detection of hearing disorders, and timely intervention (eg. cochlear implantation or hearing aid) largely prevents delayed language development,1,2,7 and also improves general developmental outcome at age 3-5.3
Despite increased consciousness that vision and hearing screening is effective, differences exist in implementation between countries. A 2002 survey of vision screening programmes in 190 countries found that screening was often state funded, visual acuity (VA) was always tested, and that in the EU screening was predominantly voluntary.8 In a 2012 survey of the International Orthoptic Association, 98% of responders indicated that vision screening programmes existed in their country, 44% were national programmes. Screening was performed by a wide range of professionals.9
An overview of universal newborn hearing screening (UNHS) in 24 European countries from 2004-2006 showed that in several countries UNHS programmes reached more than 95% of all neonates, but in many other countries programmes were recently introduced or were only partially functioning.10 Other reports on national neonatal hearing screening programmes raise issues on implementation, test procedures, type of tests, coverage, detected cases of hearing loss, and costs.11-19
A Health Technology Assessment review in 200820 re-examining the cost-effectiveness of vision screening up to the age of 4-5 (following previous report in 199721) found that, based on the accepted value of a Quality-adjusted life year, the cost-effectiveness of
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