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Our research aims to improve people's health and wellbeing by making the most efficient use of health and social care resources. To achieve this, we use real-world data and mathematical models to evaluate the costs and consequences of applying different interventions over a period of time, often the entire lifetime of patients.

Medical doctor working with operating room as concept

Our research informs the decision-making process by international, national or local authorities when they examine evidence to decide which interventions to fund, as well as supporting patients with information and tools that help them make better-informed decisions.

Real-world data is generated not from clinical trials but from observational studies, cohorts, registries, and the like. Using real-world data combined with mathematical models gives us incredible insight over what works and what does not, and allows us to maximise our resources.

We also research about outcome measures, i.e. the different ways of capturing the benefits to people of the interventions we study, and examine how well they pick up what is important for patients and how they change over time.

We conduct these analyses in the context of many different conditions, but our work generally focuses on musculoskeletal diseases, more specifically osteoporosis and fracture prevention, rare musculoskeletal diseases, and osteoarthritis.

We commonly study surgical procedures (of the hip, knee, shoulder, ankle) compared to other surgical approaches or to non-surgical interventions, as well as post-fracture care programmes for people with osteoporosis such as Fracture Liaison Services.


  • ADOPT NHSx – Most patients don't realise they have a spine fracture or are at risk of getting one. An innovative Artificial Intelligence software can now help detect spine fractures by looking at CT scans that include spine, but people have done for other reasons, such as lung or bowel problems. In this project, we aim to estimate the health benefits and costs to the NHS from adopting such an AI-based solution.

  • Blood Transfusion BTRU – This project aims to understand the current variations in NHS blood transfusion practice and identify interventions to improve the system's efficiency. To help achieve this goal, our team is conducting a systematic review that seeks to understand the cost of pre-transfusion blood testing.

  • DEdiCADE - What is the experience of “Patients like me” after total hip arthroplasty? In this project, we developed a tool to inform patients and their clinicians about how previous patients, with similar characteristics, have done in terms of pain relief, activity improvement, complication, and risk of subsequent surgeries. The tool is currently in use at the Geneva University Hospital

  • Fractured Ankle Management Evaluation (FAME) - Severe ankle injuries are usually treated surgically; however, it is unclear whether a non-surgical intervention is a better option to treat non-complex fractures. The FAME trial seeks to answer this question. Alongside this trial, our team will estimate the difference in the cost of resource inputs used by trial participants as well as the health consequences (length and quality of life) and will determine whether the non-surgical intervention provides sufficient value for money to be provided by the NHS. 

  • FRUITI -  a trial which aims to answer whether it is better for someone who has broken their hip to have the bone fixed or replace the hip joint. As health economists, our aim is to measure whether any difference in health benefit between these two choices is worth the (if any) additional cost it might create. To do this will use routinely collected hospital data to assess the health benefits and costs up to five years after the procedure. 
  • IOF Capture the Fracture - Despite the availability of effective treatments to reduce the risk of fracture, healthcare systems are delivering minimal standards for secondary fracture prevention leading to deaths and healthcare resource utilization which would have been potentially avoided through setting up a secondary fracture prevention facilities or Fracture Liaison Services (FLS). The aim of this study is to develop an economic model based on the care pathway of individuals with a fragility fracture and key elements of FLS programmes to estimate the benefits and budget impact these initiatives and to support their wide international implementation.
  • OI Costs BBS – One of our objectives is to measure both the self-reported healthcare resource use for adults with Osteogenesis imperfecta and their cost of lost productivity (to society) due to their health condition. This will be achieved by analysing completed questionnaires by participants of the rare disease cohort study, RUDY.

  • RUDY - Rare Undiagnosed Diseases StudY (RUDY) is a rare disease cohort study based in the UK which gathers information on a wide range of rare diseases for example Osteogenesis imperfecta, Multiple myeloma and X-linked hypophosphaetemia. Participants self-report their health-related quality life by completing questionnaires measuring a wide range of health dimensions, sleep, pain, quality of life, fatigue, anxiety, and depression. This online platform has given insight into the experience of individuals with a wide-range of rare diseases and enabled research into conditions often for which a lot is still unknown. 

  • STAR – For many a total knee replacement will improve their physical mobility and reduce the pain experienced prior to surgery. However for a distinct few this knee pain can persist long after surgery. The goal of this project was to estimate the consultation and prescription resource use of individuals who experience chronic pain after a total knee replacement and evaluate their progression in and out of chronic pain up to five years after surgery. Alongside this, we also analysed the cost-effectiveness of the STAR intervention (support accessing already available health resources) for individuals with chronic pain following a total knee replacement compared to usual practise of care.

  • UCB Epi and burden of IF – The aim of this study is to investigate characteristics, incidence, healthcare resource utilisation, and costs amongst postmenopausal women with fractures occurring up to 2 years after an initial one. We will use data collected from general practitioners in six European countries. This is a novel approach to use “real-world” data, (i.e.: collected for non-research purposes, such as from electronic health records, claims, registry etc.) to estimate healthcare resources and costs from multiple databases at international level.

  • XLH Carer Burden – Being a care giver can impact your day-to-day life in many ways. Our aim was to find a suitable and comprehensive questionnaire to measure the effect on individuals who care for friends or relatives with X-linked hypophosphaetemia. This questionnaire will then be included in the rare diseases cohort study, RUDY.

  • XLH Mortality – In this study, we are using data from the Clinical Research Data Link (CPRD) to estimate the real-world prevalence and management of XLH, and risk factors associated with reduced survival in XLH patients and share findings to the academic community.

  • XLH PROs – This project was an exploration of the patient-reported outcomes measures (questionnaires) of health dimensions such as sleep, pain, quality of life, fatigue, anxiety, and depression of adults with a rare disease called X-linked hypophosphaetemia. We used self-reported data from adults with XLH collected by the rare diseases cohort RUDY to measure their health-related quality of life.

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