The path to specialist multidisciplinary care in amyotrophic lateral sclerosis: A population- based study of consultations, interventions and costs.

Background: Amyotrophic Lateral Sclerosis (ALS) is a devastating neurological condition that requires coordinated, multidisciplinary clinical management. ALS is prone to misdiagnosis as its signs and symptoms may be non-specific, which may prolong patients' journey to multidisciplinary ALS care.

Methods: Using chart review and national register data, we have detailed the journey of a national cohort of ALS patients (n = 155) from the time of first symptom to presentation at a multidisciplinary clinic (MDC).

Optimisation of Healthcare Contracts: Tensions Between Standardisation and Innovation: Comment on "Competition in Healthcare: Good, Bad or Ugly?".

An important determinant of health system performance is contracting. Providers often respond to financial incentives, despite the ethical underpinnings of medicine, and payers can craft contracts to influence performance. Yet contracting is highly imperfect in both single-payer and multi-payer health systems.

"Managed competition" for Ireland? The single versus multiple payer debate.

Background: A persistent feature of international health policy debate is whether a single-payer or multiple-payer system can offer superior performance. In Ireland, a major reform proposal is the introduction of 'managed competition' based on the recent reforms in the Netherlands, which would replace many functions of Ireland's public payer with a system of competing health insurers from 2016. This article debates whether Ireland meets the preconditions for effective managed competition, and whether the government should implement the reform according to its stated timeline.

From Pharmacovigilance to Clinical Care Optimization.

In order to ensure the continued, safe administration of pharmaceuticals, particularly those agents that have been recently introduced into the market, there is a need for improved surveillance after product release. This is particularly so because drugs are used by a variety of patients whose particular characteristics may not have been fully captured in the original market approval studies. Even well-conducted, randomized controlled trials are likely to have excluded a large proportion of individuals because of any number of issues.

An assessment of the cost-effectiveness of midwife-led care in the United Kingdom.

Objectives: to analyse the existing evidence on the cost-effectiveness of midwife-led care compared with consultant-led care in settings potentially generalisable to the United Kingdom, and to estimate the potential cost savings accruing from an expansion of midwife-led care in the United Kingdom.

Design: a systematic review of the literature was conducted across twelve electronic databases for papers relating to the costs of midwife-led models of care. Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series studies were considered for inclusion.

The economic cost of chronic noncancer pain in Ireland: results from the PRIME study, part 2.

Unlabelled: To assess the economic cost of chronic pain in Ireland, information was gathered from 140 people with chronic pain. Direct and indirect costs attributable to chronic pain and medical conditions of which chronic pain was a feature were recorded retrospectively for 12 months. Mean cost per chronic pain patient was estimated at €5,665 per year across all grades of pain, with mean costs increasing according to the severity of pain.