Cost-effectiveness Analysis of Single Session Walk-In Counselling

Abstract

Background: Increased costs and demand for accessibility to mental health services accompanied by a decline in resources has forced mental health service providers and government to innovate and develop a variety of new programs and service delivery strategies. As a result, a substantial number of organizations in Ontario have adopted the walk-in/single session therapy model. Further, many more family services agencies are planning to open a walk-in counselling center. Although, there have been some studies on clinical effectiveness, only one previous study has examined the cost-effectiveness exclusively focusing on single-session therapy/walk-in counselling service and that study suffered from a small sample size and the lack of a control group. Therefore, a rigorous research that examines the economic effectiveness is of paramount need. With a large sample size and a control group, this study aims to close the existing gap in the economic evaluation of single-session therapy/walk-in counselling. Objective: To determine the cost-effectiveness analysis of a single-session walk-in counselling model of service delivery compared to the traditional counselling model. Methods: Cost effective analysis was undertaken with effectiveness measured by the General Health Questionnaire (GHQ-12) score. Cost was measured using data on direct medical costs: physician cost, hospital cost, emergency visit cost, counselling cost, and other social service cost, and indirect costs: the cost of lost work days and the cost of lost usual activities. To make the results comparable to other interventions, the GHQ-12 score was converted to QALYs using Serrano-Aguilar et al.’s (2009) algorithm. Incremental Cost-effectiveness Ratio (ICER) was calculated comparing walk-in counselling to being on the waitlist for traditional counselling. A probabilistic sensitivity analysis (PSA) was performed to account for uncertainties of parameters. In-depth analysis was done using Mixed effect modeling (also called multilevel models) to analyze the data from both individual level and group/context level and also to study growth or change trajectories (of the outcome measure) over a period of time, in order to measure the effectiveness. Perspective: The societal perspective was used for our analysis with a time period of 10 weeks. Data sources: The data from a CIHR-funded project was used. The data were collected from two family service agencies in Ontario, Canada; Kitchener-Waterloo Counselling Services (KWCS) and Family Service Thames Valley (FSTV) at three different time points: baseline, 4 weeks and 10 weeks over a period of 6 months. Results: During the ten weeks of the study, the total mean incremental costs were ($1,499.55-$1,865.10) =-$365.55, indicating that walk-in counselling was less costly than the traditional counselling. The overall incremental outcome between intervention group and control group in QALYs after 10 weeks was, on average, (0.0215-0.0176) =0.0039. Combining the incremental costs and outcome differences across intervention and control groups resulted in average point estimates of the ICER of -$93,730.77 per QALY gained. Conclusions: The single-session walk-in counselling model of service delivery is cost saving, but the effect is not significant. It enables rapid improvement and faster service to those who need immediate help.