Govert Veldhuijzen

118 Chapter 6 We developed an eHealth platform that serves as a nexus between patients and endoscopy units. CBE replaces a physical outpatient visit as patients are educated supported by video and 3D animations, health information of the patient is acquired and informed consent documented (‘ e-consent’) and a pre-sedation risk assessment is being performed. 19 Behind the scenes, auxiliary staff can manage patient flows more effectively, with a reduction of 21% of outpatient visits 20 A randomized clinical trial found that CBE is non-inferior to nurse counselling in terms of bowel preparation. 20 To investigate all costs involved with patient education prior to endoscopy, we interrogated data from the development phase of the CBE. 19 . We set out with two questions central to a comprehensive (endoscopy unit, patient and society) economic evaluation of CBE: 1. costs of the current practice of nurse counselling and 2. the cost reduction achieved by CBE. METHODS We designed the following strategy to assess costs and cost derived benefits associated with CBE and describe the methodology used to calculate the reduction in operational costs of the endoscopy unit as our primary outcome. An alternative approach based on the institute for Medical Technology Assessment (iMTA) questionnaire data was used to calculate costs related to the secondary outcomes such as patient expenses and societal costs. All costs presented in this article are in euros indexed at the price level of 2016, as most data was collected in this period. Endoscopy unit operational costs We combined the data from two prospective observational studies to answer our research questions on endoscopy unit costs. 20,21 The first study is a multicenter randomized controlled trial with four trial sites: two urban, one academic and one rural based department. In this study we compared bowel preparation quality between nurse counselled patients versus patients in the CBE group; the study demonstrated non-inferiority for the CBE on this outcome. 20 The strategy to compare costs based on a non-inferiority study is to perform a cost minimization calculation. 22 In this trial 497 patients fulfilled the per-protocol requirements. Of these patients, 217 received the nurse counselling group while 280 were CBE instructed. In the CBE group, 135/280 patients filled out a questionnaire prior to colonoscopy, containing questions regarding the patient education route followed in the CBE algorithm. Of this