Govert Veldhuijzen

116 Chapter 6 ABSTRACT AIM We developed computer-based education (CBE) to improve bowel preparation for colonoscopy and using a randomised clinical trial we found that CBE is non-inferior compared to nurse counselling using adequate bowel preparation as outcome measure (93.2% versus 94%). We set out to calculate the cost minimization effects of CBE. METHODS We performed cost minimization calculation using a cost model for three patient routes (nurse counselling, CBE alone and both). This model includes wages of staff, CBE implementation and license costs. We calculated per visit costs of both strategies using the Institute for Medical Technology Assessment (iMTA) costing tool and the reported average travel distance for colonoscopy in the Netherlands in both scenarios. The iMTA Productivity questionnaire was used for adapted cost friction. For statistical analysis, we performed bootstrap to compare results and to calculate 95% confidence limits. RESULTS The adaptation of the cost model after process evaluation resulted in 33 relevant parameters for cost calculation. Input on all parameters was retrieved in the four trial units. This resulted in varying costs for the three patient routes per trial site: nurse counselling €18,30 - €28,42, CBE alone €4,04 - €8,86 and CBE with additional counselling €7,01 - €19,78. Data in the CBE group was imputed (135 to 280 patients). The endoscopy unit paid on average €8,36 (CI €7,83-€8,84) per patient in the CBE group. In the nurse counselling group, this was significantly higher, €22,56 (CI €22,00–€23,12). The average patient out of pocket costs were €5,80 for a nurse visit. With mandatory visits in 100% and 3% of the cases, the total cost made by all patients were €1260,09 in nurse counselling versus €46,45 in the CBE group. In total 271 patients (125 nurse counselling, 146 CBE group) completed the iMTA questionnaire. In the nurse group, 54 (43.2%) patients reported absence from either paid or unpaid work of needing replacement for unpaid work, versus 29 (19.8%) in the CBE group (p=0.007). The e calculated productivity loss was significantly higher in the nurse counselling group: €35,84 (95% CI: € 26,79 -€48,41) versus CBE: €13,89 (95% CI: €7,64 – €18,84). CONCLUSION CBE reduces costs for endoscopy units, patients and society.