Cost-effectiveness Analysis of Single Session Walk-In Counselling

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

Cost-effectiveness analysis of single-session walk-in counselling

Background: An increasing number of family service agencies and community-based mental health service providers are implementing a single-session walk-in counselling (SSWIC) as an alternative to traditional counselling. However, few economic evaluations have been undertaken. Aims: To conduct a cost-effectiveness analysis of two models of service delivery, SSWIC compared to being waitlisted for traditional counselling. Methods: A quasi-experimental design was employed. Data were collected from two community-based Family Service Agencies, one using SSWIC and one using traditional counselling. Participants were assessed at baseline and four weeks after the baseline. Cost-effectiveness was estimated from the societal and payer’s perspective. Results: The societal and payer’s costs for SSWIC were higher than for those waiting for traditional counselling, and health outcomes were better. SSWIC is not cost-effective compared to being on the waitlist for traditional counselling (or, for a few patients, having received counselling, but after a wait of several weeks). Conclusions: SSWIC has the potential to reduce the pressure on the mental health care system by reducing emergency visits and wait lists for ongoing mental health services and eliminating costly-no shows at counselling appointments. Long-term studies involving multiple walk-in counselling services and comparison services are needed to support the findings of this study

Prevalence of Metabolic Syndrome among the Patients Attending for Master Health Check-up in Family Medicine Department

Introduction: Metabolic syndrome (MetS) is a cluster of conditions that occur together, increasing risk of heart disease, stroke and type 2 diabetes. The prevalence of MetS is increasing worldwide. The aim of the study is to determine the prevalence of MetS among patients attending for Master Health check-up at Family Medicine outpatient department, to find out common component and see the association of body mass index with MetS. Methods: This cross-sectional observational study was done at family medicine outpatient department over a period of six months. There were total of 854 participants involved in the study and each subject was interviewed, anthropometric measured, biochemical parameter recorded in the Performa. The MetS was diagnosed according to modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Results: The MetS was diagnosed in 53.9 %( 95% CI:50.56%-57.24%)of the study population on the basis of modified NCEP-ATP III criteria, with prevalence significantly higher among males (58.3%) than in females (48.6%)(P value <0.01). Abdominal obesity (70.7%) was the most common morbidity followed by increased fasting blood sugar (57.1%), high level of triglyceride (45.4%), high blood pressure (45.0%) and low level of high density lipoproteins (41.0%). Prevalence of metabolic syndrome was significantly (p-value=0.000) high among obesity (82.5%) and overweight (67.6%) individuals than those with normal weight (38.7%) and under-weight (7.1%). Conclusion: The metabolic syndrome was seen in more than half of study population, with significantly higher among males than in females. The most common component in both genders was abdominal obesity. Presence of any one component should alert the primary care physician to look for other components so that definitive diagnosis can be made and timely intervention can be started with dietary measures, regular exercises and medical treatment

Using the ages and stages questionnaire in the general population as a measure for identifying children not at risk of a neurodevelopmental disorder

Abstract Background Early detection of neurodevelopmental disorders (NDDs) enables access to early interventions for children. We assess the Ages and Stages Questionnaire (ASQ)’s ability to identify children with a NDD in population data. Method Children 4 to 5 years old in the National Longitudinal Survey of Children and Youth (NLSCY) from cycles 5 to 8 were included. The sensitivity, specificity, positive and negative predictive values were calculated for the ASQ at 24, 27, 30, 33, 36 and 42 months. Fixed effects regression analyses assessed longitudinal associations between domain scores and child age. Results Specificity for the ASQ was high with 1SD or 2SD cutoffs, indicating good accuracy in detecting children who will not develop a NDD, however the sensitivity varied over time points and cut-offs. Sensitivity for the 1 SD cutoff at 24 months was above the recommended value of 70% for screening. Differences in ASQ domains scores between children with and without NDD increases with age. Conclusions The high specificity and negative predictive values of the ASQ support its use in identifying children who are not at the risk of developing a NDD. The capacity of the ASQ to identify children with a NDD in the general population is limited except for the ASQ-24 months with 1SD and can be used to identify children at risk of NDD

Additional file 1: of Using the ages and stages questionnaire in the general population as a measure for identifying children not at risk of a neurodevelopmental disorder

The flow chart for the selection of samples for the short and the long short. First, children with NDD were identified and followed them in the previous cycle(s) for ASQ scores. (DOCX 2 kb