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Health economics

CEDAR has expertise and experience in health economics. Megan Dale is our lead Health Economist. We are contracted by NICE to critique and amend company-submitted economic evaluations for the Medical Technologies Evaluation Programme

CEDAR's health economic projects


Cortisol monitoring device

Researchers at Bristol Medical School are currently developing a continuous cortisol monitoring device which measures cortisol levels in real time. The system consists of:

  • a small microdialysis probe that is inserted just under the skin
  • a thin tube connecting the probe to the sensor unit
  • a hand held, ambulatory sensor unit that collects the samples and senses cortisol levels
  • a display tablet real time, pulsatile, cortisol levels, connected via Bluetooth

The unit can be worn by a patient for up to 48 hours, with readings available after an initial 20 minutes stabilisation. The microdialysis technique means that no blood samples are required, avoiding blood loss and the time and resource for taking blood tests. The patient can continue normal activities during the monitoring process.

CEDAR will look at how clinicians in different areas view the potential of this device and the NHS pathway changes that may be associated with it, and consequent health economic implications.


Welsh Crucible

CEDAR are collaborating with Cardiff Metropolitan University and Swansea University in a multi-disciplinary project supported by Welsh Crucible. The project aims to optimise flowable composite material properties and examine the challenges in integrating sensors into composite specimens that allow real-time data acquisition and visualization. This work forms the basis of future developments towards enabling smart biomedical implants.

CEDAR’s role is to investigate where smart orthopaedic implants could fit within existing and future NHS pathways. We will investigate what potential impacts are both in terms of patient outcomes and healthcare resource use.


OBS Cymru

OBS Cymru was a three year national quality improvement project that aimed to standardise care and reduce both morbidity and mortality rates associated with postpartum haemorrhage (PPH) across all Welsh maternity settings. The improvements in care have now been embedded in maternity units across Wales. CEDAR carried out an economic evaluation using data collected during the project that demonstrated consistent savings in blood product use, crucial care utilisation and haematology consultant time. The evaluation considered the impact of maternity unit size and the uptake of the intervention. More information is available here.

Dale, M., Bell, S., Scarr, C., Collis, R. James K Carolan-Rees G., Collins P. (2020) OBS Cymru: a health economic evaluation. Obstetric Anasesthetists Association Conference, P1. Available from: Accessed February 2021

Dale, M., Bell, S., Scarr, C., Collis, R. James K Carolan-Rees G., Collins P. (2020) OBS Cymru: a health economic evaluation. International Journal of Obstetric Anaesthesia. Vol 44, Supplement 1. S1-S62. Available at Accessed February 2021


Selective internal radiation therapy

NHS England commissioned a full economic evaluation of selective internal radiation therapy for the treatment of advanced liver metastases.

White J., Dale M., Morgan H., Sewell B., Carolan-Rees G. (2017) Commissioning through Evaluation: Selective internal radiation therapy (SIRT). NICE Commissioned report for NHS England 2017. Available at:


Oral health in care homes

On behalf of NICE, CEDAR carried out an economic evaluation on oral health in care homes.

Cleves A, Jones M, Morgan H, Fitzsimmons D, Alam F. (2016) Economic report: Oral health for adults in care homes. Available at:


Transmission - Radiotherapy Active Pixel System (TRAPS)

CEDAR completed a health economic cost comparison of a novel method to measure patient dose during radiotherapy, compared to existing alternatives. A functional model was produced to enable exploration of the device in different pathways and settings. Project II-LA-0214-20004 was funded by the NIHR as part of the Invention for Innovation (I4I0 funding scheme. Discussions are now taking place between the project team and two commercial companies to determine whether it will be feasible to take the device forward into development.  The project team have expressed their appreciation for the cost comparison model as a starting point for discussion of the financial aspects.


Pressure Ulcer Prevention and Intervention Service, South West (PUPIS)

The PUPIS SW project brought together people from different clinical specialities and resulted in sharing ideas and building new links between people. CEDAR evaluated and reported on the Pressure Ulcer Outreach Service in Salisbury, and compared different models of equipment provision. 

Dale M., Cox-Martin B., Shaw P., Carolan-Rees G. (2014) Cost-effective non-surgical treatment of chronic pressure ulcers in the community. British Journal of Community Nursing, Vol. 19, Iss. Sup1, 07, pp S6 - S12


Operative hysteroscopy outpatient clinic (Health Foundation Shine Award)

Led by Mr Richard Penketh (Consultant Obstetrician and Gynaecologist) the Cardiff Shine team established an operative hysteroscopy outpatient clinic for treatment of uterine fibroids and polyps under local anaesthetic using reusable equipment. This procedure is conventionally done in surgical theatres under general anaesthetic which is inconvenient for patients, has associated risks, and has a high resource-use burden. CEDAR carried out independent patient satisfaction phone interviews, analysis of the clinical data, and an economic evaluation of the clinic compared to standard care under general anaesthetic in theatres.

Penketh R.J.A., Bruen E.M., White J., Griffiths A.N., Patwardhan A., Lindsay P., Hill S., Carolan-Rees G. (2014) Feasibility of resectoscopic operative hysteroscopy in a UK outpatient clinic using local anaesthetic and traditional reusable equipment, with patient experiences and comparative cost analysis. Journal of Minimally Invasive Gynaecology Sep-Oct;21(5):830-6.