Cell salvage involves the recycling of a patient's own blood shed during or after an operation. The procedure is mainly used in the specialties of orthopaedics, cardiac and obstetrics where high volumes of blood loss are expected. The cell salvage process can therefore obviate the need for a patient to require a blood transfusion using donated (allogeneic) blood. This thesis examines the cost effectiveness of cell salvage in primary total hip replacement surgery. It compares data for three hospital sites in England; one an extensive user of cell salvage and two sites that do not utilise cell salvage. The thesis concludes that recent procedural changes and the adoption of published blood management guidance can reduce the requirement for a patient to require an allogeneic blood transfusion. These changes render both intra-operative and post-operative cell salvage unnecessary to support most primary total hip replacement operations. The thesis recommends further comparative studies in surgery with higher potential blood loss to assess the impact of intra-operative cell salvage in a less predictable operating environment.