The need for and relevance of student counselling has been well argued for in past research, and has been duly recognised at governmental level in South Africa. However, this recognition necessarily calls for accountability from student counselling centres. In this regard, it becomes increasingly important to evaluate student counselling services in terms of their cost-effectiveness and the impact their services have. In this article, different methods for determining cost-effectiveness are outlined and the most applicable method in different cases indicated. Subsequently, research on cost-effectiveness and the impact of student counselling services are reviewed. Research findings on the impact and cost-effectiveness of policies, organisational structure, collaboration between different institutional service centres and counsellor characteristics are reviewed. In particular, it was found that collaboration between student-directed services within the broader University context contribute to cost-effectiveness and impact. It is concluded that more empirical research is needed to justify the claims of relevance of student counselling services. Suggestions are made as to how impact and cost-effectiveness can be studied at institutional level. Furthermore, it is suggested that research findings on counsellor characteristics should be integrated in the impact and cost-effectiveness studies of student counselling services. (Contains 6 notes.)