Govert Veldhuijzen

173 Discussion and future perspectives For patient costs, we calculated per visit cost 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 all three scenarios. Finally, to assess societal costs, we used the adapted cost friction iMTA Productivity questionnaire. We performed bootstrap to compare results. The development of the cost model after process evaluation resulted in 33 relevant parameters. 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. The difference in costs amongst trial sites was mainly explained by the length of consultation time and use of more expensive personnel. With extrapolated data (135 to 280 patients) in the CBE group the endoscopy unit paid on average €8.36 (CI €7.83-€8.84) per patient. 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, 146 CBE group) filled out the iMTA questionnaire. Gender was similar distributed in both groups. 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 mean number of hours reported was not significantly different, but the 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). Computer based education showed a cost reducing effect for endoscopy units and lowers expenses made by patients and society. This study fuelled the evidence base of the benefits of this eHealth intervention. Full implementation of this modality will free up valuable health care resources. eHealth application during endoscopy To evaluate the impact of eHealth solutions during colonoscopy we performed a proof of concept pilot study on virtual reality (VR) glasses in chapter 7 . Main goal was establishing the feasibility of this intervention during colonoscopy. If VR would not compromise the technical success of colonoscopy, this could pave the way for future trials to evaluate if this device could serve as a potential substitution of sedative and analgesic drugs. We included adults referred for colonoscopy and divided them in two groups: with and without VR glasses. Main outcome was patient acceptance of wearing 9