The economics of employing a counsellor in general practice : Analysis of data from a randomised controlled trial

Background. Counselling is currently adopted in many general practices, despite limited evidence of clinical and cost effectiveness. Aim. To compare direct and indirect costs of counsellors and general practitioners (GPs) in providing care to people with emotional problems. Method. We carried out a prospective, randomized controlled trial of non-directive counselling and routine general practice care in 14 general practices in north London. Counsellors adhered to a Rogerian model of counselling. The counselling sessions ranged from one to 12 sessions over 12 weeks. As reported elsewhere, there were no differences in clinical outcomes between the two groups. Therefore, we conducted a cost minimisation analysis. We present only the economic outcomes in this paper. Main outcome measures were cost data (service utilisation, travel, and work absence) at baseline, three months, and nine months. Results. One hundred and thirty-six patients with emotional problems, mainly depression, took part. Seventy patients were randomised to the counsellors and 66 to the GPs. The average direct and indirect costs for the counsellor was ?162.09 more per patient after three months compared with costs for the GP group; however, over the following six months the counsellor group was ?87.00 less per patient than the GP group. Over the total nine-month period, the counsellor group remained more expensive per patient. Conclusions. Referral to counselling is no more clinically effective or expensive than GP care over a nine-month period in terms of direct plus indirect costs. However, further research is needed to establish indirect costs of introducing a counsellor into general practice.