Lamsal, Ramesh2014-08-252014-08-252014-08-252014http://hdl.handle.net/10012/8696Background: 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.enEconomic EvaluationMaster ThesisHealth Studies and Gerontology