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Huibert Jan Simonsz, Frea Sloot, ; Startup of EU consortium for cost-efficiency optimization of population-based screening and development of EU screening guidelines. Invest. Ophthalmol. Vis. Sci. 2014;55(13):430.
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© ARVO (1962-2015); The Authors (2016-present)
To raise cost-efficiency of screening, EU-guidelines should be developed, but how to decide on the best screening program? Among EU member states these vary from visual acuity at age 4 to refraction at age 1. Youth health care doctors screen in the Netherlands, pediatricians in Germany, nurses in Sweden and general practitionners elsewhere. The number of exams ranges from 1 to 7 while half the countries have no population-based screening yet. We previously developed a microsimulation model (ARVO 2010 #4356) to evaluate the effectiveness of screening programs. We now build a EU consortium to employ the model for optimization of screening cost-efficiency in Europe.
In its basic form, the model (figure) uses input data from screening studies, estimated prevalence functions for strabismic, combined-mechanism and refractive amblyopia, sensitivity and specificity of screens determined by several other factors, and estimates of the effect of therapy, to calculate the effect of a screen. To build the consortium among the 36 EU (full, associate and candidate) member states, pediatric ophthalmologists and orthoptists are invited, together with (the consortium also studies ear and speech screening) ENT-surgeons, audiologists and representatives of the screening professionals, into country committees for gathering input data.
The microsimulation model has performed well in predicting the outcome of disinvestment of preverbal eye screening (ARVO 2014, F Sloot et al). However, the model had been validated primarily with the data of the RAMSES observational birth cohort study (IOVS 2010;51:3476-84), and needed additional work to accommodate most of the variation found within European screening regarding age, interval, test, personnel, infrastructure etcetera. In the study consortium, 26 EU countries are represented by pediatric ophthalmologists. Orthopists are invited into the country committees by a mandate of the Orthoptistes de la Communauté Européenne (O.C.E.).
To have widely different guidelines for screening in many EU member states and to revise these guidelines in all of these countries every 5 years seems inefficient. The microsimulation model allows us to compare these diverse screening programs and to reach dynamic EU screening guidelines, that are sensitive to local circumstances
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