Page 28 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

CHAPTER 2
screening for amblyopia depends on the long-term utility effects of unilateral vision loss and that there was currently no sustainable evidence of utility loss that would render any form of screening likely to be cost-effective.20 Keren et al. concluded that UNHS in general has the potential for long-term cost savings compared with selective hearing screening and no screening.22 Burke et al found that the cost-effectiveness of hearing screening depended mainly on the cost of the screening intervention per patient and on the prevalence of hearing loss in the population.23
We aimed to compile an inventory of population-based vision and hearing screening programmes for children in Europe, and to quantify and examine the differences. This study should assist those countries without a screening programme and new EU member states in selecting which screening protocol to adopt. If large differences between programmes in EU countries are found, further study on the relative costs and effectiveness of the different approaches to screening will be necessary.
METHODS
Drawing particularly from five major cost-effectiveness analyses,20, 21,23-25 we selected the following items to formulate vision (Q1) and hearing (Q2) screening questionnaires:
- Type of tests, eg. visual acuity chart or hearing screening device used (otoacoustic
emission (OAE), automated auditory brainstem response (aABR))
- Professions involved in screening, eg. nurses, orthoptists, doctors
- Funding, eg. State, health insurance
- Coverage, percentage of screened children
Questions formulated in a focus group were structured as multiple-choice with room for comments and multiple answers (See Appendix Q1, Q2). All forms of screening for vision or hearing problems were included (eg. inspection of the eyes was also counted as form of vision screening). To obtain a broader perspective of screening systems, a short public health questionnaire (Appendix Q3) to provide background information on screening and screening systems in all countries was developed through extrapolation of the vision and hearing questionnaires.
In each of the 28 EU full member states, five candidate states, potential candidate state Albania and associated states Israel, Moldova, Norway, and Switzerland, a paediatric ophthalmologist, orthoptist, otolaryngologist, audiologist and screening professional
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