Govert Veldhuijzen

125 CBE before colonoscopy is reducing operational costs, with lower patient and societal expense implementation process of the CBE in 2016. (Table 3.) Full implementation is crucial to achieve the maximal costs reduction. Table 3. Conversion rates and cost savings of patients educated via CBE platform in the first year of implementation (published earlier, reprint with permission) Rates per year Target Actual 2016-2017 Conversion  Hospital A  Hospital B  Hospital C  Hospital D 60% 80% 80% 80% 35% 40% 27% 50% Cost savings  Hospital A  Hospital B  Hospital C  Hospital D €4958,67 €49.916.54 €53.814,96 €62.115,60 €-2652,60 €12.860 (FORECAST) -€27.024 (FORECAST) €31.065,94 Strengths and limitations A major strength of this article includes the refined basis of all calculations made. The high detailed cost model allows for robust statements on cost minimization effects. The triangular view (endoscopist, patient and society) gives a complete insight when it comes to the economic evaluation of the CBE. Moreover, our CBE is one of few enhanced patient education modalities to produce data on the cost saving effect. A limitation might be that nurse counselling visits prior to endoscopy appears to be quite specific for the Dutch endoscopy unit. Although this has led to the successful implementation in 26 units across the Netherlands, generalizability of the measured cost reducing effects to other countries might be hampered. As with all cost evaluation studies, there is to some extend the risk of assumption bias. The use of extrapolated data in this study is also a limitation. CONCLUSION Computer based education shows a cost reducing effect for endoscopy units and lowers expenses made by patients and society. This study fuels the evidence base of the benefits of this eHealth intervention. 6