Govert Veldhuijzen

172 Chapter 9 with the standard of care (nurse counselling), both endoscopic quality measures and patient related outcome measures were valuated. Evaluation of computer based education In chapter 5 we report on our prospective, multicenter, endoscopist blinded, non- inferiority randomized controlled trial. The primary outcome was successful bowel preparation, using the Boston Bowel Preparation Scale (BBPS). Secondary outcome measures were sickness absence due to outpatient’s clinic visit, patient anxiety and satisfaction scores and information re-call. The study was performed in four endoscopy units of different levels (rural, urban, and academic). We screened 1035 eligible patients and randomized 845. After evaluation, 684 were included in the intention-to-treat (ITT) group. Subsequently, 497 patients were included in per-protocol (PP) analysis, 217 in nurse counselling and 280 in the CBE group. Baseline characteristics were similarly distributed among groups. In PP analysis, adequate bowel cleansing was achieved in 93.2 % (261/280) of CBE patients, which was non-inferior to nurse counselled patients (94%, 204/217), with a difference of -0.8% [95% CI [- 5.1; 3.5]%. Non-inferiority was confirmed in the ITT population. Sickness absence was significantly more frequent in nurse counselled patients (28.0% vs 4.8%). In CBE patients, 21.5% needed additional information, resulting in 3.0% extra outpatient visits. Therefore, we concluded that CBE is non-inferior to nurse counselling in terms of bowel preparation during colonoscopy, with lower patient sickness leave. The CBE platform reduced outpatient visits. Therefore, the recommendation was made that CBE may serve as an efficient educational tool informing patients before colonoscopy in routine clinical practice. With every improvement or change in clinical care pathways cost issues must be evaluated. This is pivotal for endoscopy units who are deciding on their pre-procedural counselling strategy. We analysed the current cost of nurse counselling and which cost savings could be attributed to CBE in chapter 6 . As CBE replaces a nurse counselling visit it might have several cost minimization effects; we evaluated this primarily from the perspective of the endoscopy unit. We also included both the patient and the societal viewpoint by calculating patients’ travel costs and productivity loss. To evaluate endoscopy unit expenditure, we developed a cost model to establish the associated costs for three patient routes before colonoscopy (nurse counselling, CBE alone and with additional counselling). This model comprised wages of auxiliary staff, CBE implementation and license costs and other factors derived from process flow review. We applied this model to perform cost minimization calculation of the CBE versus the nurse counselling strategy based on extrapolated data from our earlier trial.