Model Development

The model version is good, but multi-institution forecasting is not the best. I suggest that only kindergartens and schools be taken.
Thank you for your suggestion. We have discussed your comment with the developers of the model and it will be looked further into.

At school there might be range of people available who might be potential screeners (teachers/ school nurses/ visiting GPs / parents) but only one option allowed.
The user would have to run the same programme several times, with only the profession being changed.

How tolerant of the model is a response like 4-5yrs, or 5-6 yrs? (in the UK it is the school year in which they are 5, but in other places children may only start after a specific birthday) – guidelines about how should they answer?
Good suggestion, we will give more information on what to fill out here. Decimal numbers are possible.

Has there been a EU decision / consensus on what actually constitutes an optimal UNHS screen? Surely we need to have a consensus, even if it remains aspirational for countries to achieve.
The cost-effectiveness model calculates the most optimal UNHS programme given the local circumstances. This can be different across countries. A consensus on what constitutes an optimal UNHS programme will vary between countries, but guidelines are an outcome of this study.
Within the current model, only detection of a hearing loss >40dB is calculated, but the model development team will address issues of sensitivity in the coming year.

The diagnostic testing is performed by different staffing / grades with totally different equipment.
We are aware of this issue. At the moment, the model uses an average total cost for the diagnostic assessment. Therefore, an average cost is asked for.

Costs for diagnostic assessment or screening assessment? This is not clear – am I costing the pathway from screen through to immediate diagnostics or is just the screening?
The model will calculate the cost-effectiveness until the diagnosis is made. Separate costs should be provided for screening and diagnostic assessment.

I am confused if you are costing screening or diagnostics with audiologist.
Both are possible. We ask what professionals perform screening and the average salary costs for these professionals. For diagnostics, the salary costs are included in the average cost of diagnostics. This will become more detailed in a next version of the model.


Additions to the model in 2020

At the moment, the model only calculates the cost-effectiveness of neonatal hearing screening for well babies. In 2020, neonatal hearing screening for NICU infants will be added as well as (pre-)school screening.

At the moment, the model only calculates the cost-effectiveness of screening for amblyopia via visual acuity at (pre-)school age. Red reflex, white pupil, external exam and photoscreening will be added in 2020.

Costs for the screening programme and diagnostic assessment will be more detailed next year.
Costs and options for leasing equipment will be added later.
Costs and time put in by parents may be added later.


Web Development

Changes made
• Additional professionals are added in the drop down box ‘GP practice nurse’ and ‘Health Visitor’
• Only the region has to be filled out before calculating the cost-effectiveness of a programme
• ‘Your suggested screening programme’ was confusing, this title was changed
• ‘another contact’ was added as a choice in the drop down menu
• ‘other screening contact was added as a choice in the drop down menu
• ‘minimum school compulsory age’ was moved to the contact moments
• Additional information was added to ‘The number of VA charts needed’ to clarify this is meant for the whole programme
• The number of years a VA chart can be used for was deleted, a default value of 10 years will be used
• A definition on sensitivity was added
• Clarification was added on the costs for diagnostic assessment
• Misalignment of the boxes will be fixed
• Additional information is provided on the indicators in the pre module
• It will be possible to save answers in a later version of the website
• It will be possible to autofill some of the boxes in a later version of the website later so that the model can be run several times while changing 1 parameter



Are they meant to know which tests to use, and how long they take? (If they haven’t got screening or experience, they might not know) How will they know which chart to choose?
I don’t understand what I am meant to put in here – e.g. sensitivity – who decides? Some people without much experience might need some more guidance.
The disclaimer now states that this calculation programme is meant for people who are familiar with the terms, have access to people with knowledge about it, know how long a VA measurement takes, etc. It is not possible for the model developing team to decide what charts to suggest, that is up to the user or the professionals that the user asks for information.

How many VA charts are needed – per school, per region? How are they meant to know how long they will last?
This question regards the whole region/country that the user is calculating the cost-effectiveness for, this will be explained in more detail. The question on how long the charts will last will be deleted, a default value of 10 years will be used.

Does the currency carry through to all cost boxes?
Yes, once you have filled out a currency, this carries through to all the cost boxes.

Salary – ? include salary per annum as an option and include number of hours contracted to work per week.
This will be clarified on the website.

First time I submitted I missed the request for school attendance to be added to this list, I just focussed on health contacts. Perhaps make this clearer by having a section to report compulsory school contacts and another for health contacts.
The minimum school compulsory age will be asked on the page before to increase the visibility of the question.

I wasn’t sure how many professionals to include here, just the ones I had suggested on a previous screen? Should we ask for salary of any professional(s) that could deliver vision screening
Only the screeners that are mentioned before will be asked again on this page. The web developer is working on this.

Pre module
Maybe you could give a short descriptions in the first part about each indicator – what it is or why it is important.
We will add more information on the indicators asked in the first part of the webtool, as you suggested.

Explain up front that this is because for some circumstances vision or hearing screening may be inappropriate – people might wonder why it’s there.
We will explain this in more detail.

Define SDG indicators abbreviation in intro.
We will explain this in more detail.

Perhaps have the SDG and WGI links in colour? It’s not clear they are links until you happen to hover over them.
The links will be given a more notable colour.

For the four questions on the right relating to WW governance indicators, give information on how to complete. For consistency in completion perhaps give an example, if value =1.25 record as 1.5, if value =1.20 record as 1.0.
This information will be added.