Communicative skills at young age are crucial for health, employment and quality of life in later life. Screening for vision and hearing disorders in children, followed by early treatment, have shown to be highly effective. Early detection and treatment of a lazy eye prevents lifelong visual impairment and loss in quality of life. Early treatment of hearing impairment prevents delayed language development. EU-directives (e.g. 16620/11) give priority to these programmes, since they may impact tens of thousands of children and their parents.
However, across Europe strong variation exists in the implementation of vision and hearing screening programs (VAHSPs) for children. In high-Income Countries (HICs) VAHSPs vary regarding age and frequency of testing, tests used, uptake, screening professionals, referral pathway and funding. This makes it difficult for policy makers and professionals to decide what VAHSP to implement in Low- to Middle-Income Countries (LMICs) and how.
In this study, data relevant for screening, on demography, circumstances for screening, existing health systems, uptake, screening tests, diagnostics, treatment, health benefits, societal costs and adverse effects, will be gathered in all EU-countries and used by a decision-analytic, cost-effectiveness modelling framework of repeated screening to develop country-specific, cost-optimised, evidence-based VAHSPs that will be implemented in two LMICs. After the implementation studies, the cost-effectiveness modelling framework and a strategy for implementation will be packed into a transferable TOOLKIT that will assist healthcare providers, policy makers and professionals in their decisions to introduce or modify childhood vision and hearing screening programs.
Objective 1: Screening experts from all 41 EU-countries will report on demography, circumstances for screening, existing screening programmes and health systems, uptake, screening tests, diagnostics, treatment options, envisaged health benefits, societal costs and adverse effects in their country.
Objective 2: From these data and from the literature, the current provision of childhood screening, the types of screening programmes used and the key features of vision and hearing screening programmes will be identified across Europe.
Objective 3: A decision-analytic, cost-effectiveness modelling framework of repeated screening will be prepared and populated with the reported data and with data from the literature.
Objective 4: Current VAHSPs will be evaluated for their impact on health outcomes, cost-effectiveness and compliance with WHO-criteria for screening.
Objective 5: Two model-developed VAHSPs will be tested in two large-scale implementation studies: In the county of Cluj in Romania for vision screening, and in three counties in Albania for hearing screening.
Objective 6: A strategy for implementation will be developed from detailed tracking of the implementation studies, from identified requirements, facilitators and barriers, and from good-practice guidelines for existing VAHSPs.
Objective 7: The decision-analytic modelling framework and the strategy for implementation will be packed into a transferable TOOLKIT that will assist healthcare providers and policy makers in Europe and beyond in their decisions about introduction or modification of VAHSPs in their country.
Important note for objective 5: The model will decide what the best screening programme is and, in principle, the model could give any answer. However, as all vision screening programmes in Europe include some form of measurement of visual acuity at age 3 – 6, we have planned the implementation study in the County of Cluj accordingly, leaving room for all other variables to be determined by the model. Similarly, as all hearing screening programmes in Europe include neonatal hearing screening, we have planned the implementation study in the Counties of Tirana, Progadec and Kukës accordingly, leaving room for all other variables to be determined by the model.