Page 29 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

Inventory of current EU paediatric vision and hearing screening programmes
were selected, based on their involvement in paediatric vision and hearing screening, and asked to complete the questionnaires for their own country. Public health representatives were identified through the Ministries of health or recommendation from the vision and hearing representatives.
The questionnaire included questions about screening tests, age, and frequency of screening. Different tests can be used to screen for one disorder, but screening programmes can also focus on more than one disorder. Two-stage or multiple-stage testing improves the screening specificity but increases screening costs, although higher specificity can reduce diagnostic follow up costs.23,26
Questions about the range of professions involved in screening were included because this influences the quality and costs of screening. Screening tests with higher sensitivity and specificity might require higher educated personnel and higher salary costs, which will increase the costs of screening. This increase in costs should be balanced with the increase in sensitivity and specificity.
The questionnaire also covered funding sources, including state, regional, municipal, Health insurance, parental and/or charity. The choice of funding agencies will influence the equity of screening, competitiveness, costs, coverage and cost-effectiveness. Questions about coverage were included because the participation frequency of a screening programme is crucial for its effectiveness, and to make screening worthwhile from a population perspective. Low coverage can lead to delayed provision of the correct treatment and increased disease burden. If screening is free or compulsory, coverage will be higher. Acceptable participation frequencies may be reached by incorporating screening into an existing system with a high participation rate, eg. vaccination programmes or school start.
Questionnaires were emailed from December 2013 until April 2014. Clinicians involved in population-based screening were identified and their answers were cross-checked with those given by general screening professionals. If answers were ambiguous the questionnaires were returned to both the clinician and the screening professional and they were asked to contact each other to agree corrections. Overviews of the questionnaire answers were circulated three times to all representatives. All representatives were asked to review and correct any errors in the overviews for their own country and neighbouring countries. The overviews were also checked by external experts, involved first-hand in vision and hearing screening.
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