HealthTechCost Optimizationeu-west-190 Days$47k → $29k / mo
Case Study · UK HealthTech

How a UK HealthTech cut $18k/month off their AWS bill in 90 days

A 4× growth-stage HealthTech serving European customers had AWS spending climbing faster than revenue. We delivered 38% reduction without touching reliability, and turned cost optimization into a sustained engineering practice.

Client Profile
UK HealthTech Scale-up
IndustryHealthTech / Digital Health
StageGrowth Stage
Team Size~140 employees
AWS Regioneu-west-1 (Ireland)
Engagement10 weeks total
ComplianceGDPR · ISO 27001
38%
Monthly bill reduction
$214k
Annualized savings
8.4×
ROI on engagement fee
0
Reliability regressions
The Challenge

Engineering optimized for speed. Now finance needed the same.

After 4× growth in 18 months, AWS spend had become the second-largest line item in the company's P&L, and was still climbing. The CTO needed savings without slowing delivery.

Before, The Pain

$47k / month and growing

  • AWS bill grew 4× in 18 months, outpacing revenue growth
  • Reserved Instances purchased 18 months ago, never re-evaluated
  • EKS clusters provisioned for peak load, idle 60% of the day
  • 5 unattached EBS volumes from terminated instances
  • 3 RDS instances over-provisioned 4× actual workload
  • 40+ EC2 instances candidates for Graviton, still on x86
  • NAT Gateway egress costs rising due to VPC architecture
  • Engineers had no visibility into per-team cost
Goal, The Brief

30%+ reduction in 90 days

  • Cut monthly AWS bill by at least 30% within one quarter
  • Zero reliability regressions, production SLA must hold
  • No reduction in backups, multi-AZ, or DR capacity
  • Establish per-team cost visibility for engineering
  • Maintain ISO 27001:2022 evidence collection throughout
  • Build sustainable practice, not one-time savings
  • Read-only access only during audit phase
  • Daily standups, weekly written status to CTO + CFO
Our Approach

Three phases. Each one shipped savings.

Rather than a 12-week analysis with a giant remediation list at the end, we sequenced the work so savings appeared on the bill within the first two weeks, and compounded from there.

Phase 1 · Week 1–2 · Audit

Read-only audit + quick-win identification

Started with read-only AWS access via cross-account IAM role. Pulled 90 days of Cost Explorer data, ran Compute Optimizer recommendations, audited every Reserved Instance against actual usage, and inventoried idle resources.

  • Cost Explorer + Compute Optimizer deep review
  • Reserved Instance / Savings Plan portfolio analysis
  • Idle resource hunt across EBS, EIP, NAT, RDS, ALB, EKS
  • Per-service spend analysis and tagging audit
  • Outcome: 23-item savings roadmap, prioritized by $/month impact and risk
Phase 2 · Week 3–6 · Quick Wins

$10.5k/month locked in within 30 days

Started with the lowest-risk, highest-impact items first. Idle resource cleanup, RI/Savings Plan rebalancing, and right-sizing the worst-offender EC2 instances. Each change went through dev → staging → 5% canary → full production.

  • Removed 5 unattached EBS volumes ($530/mo immediate)
  • Right-sized top 22 over-provisioned EC2 instances ($4.1k/mo)
  • Re-balanced RI portfolio: sold mismatched RIs, bought Compute Savings Plans ($6.5k/mo)
  • Migrated CloudWatch Logs retention from indefinite to 90-day with archive ($0.4k/mo)
  • S3 Intelligent-Tiering migration on 3 largest buckets ($1k/mo)
Phase 3 · Week 7–10 · Deep Optimization + FinOps Culture

$7.2k/month additional + sustainable practice

Architectural changes that took longer to validate but compounded existing savings. EKS rightsizing, Graviton migration for eligible workloads, NAT Gateway consolidation. In parallel, set up the per-team cost visibility and weekly review cadence that turns one-time savings into sustained discipline.

  • EKS cluster rightsizing with Karpenter for auto-scaling ($3k/mo)
  • Migrated 18 EC2 instances to Graviton ($2.3k/mo)
  • NAT Gateway consolidation, VPC endpoint usage ($1.4k/mo)
  • Aurora rightsizing on 3 RDS instances ($0.5k/mo)
  • Per-team cost allocation tags + Grafana dashboards
  • Cost Anomaly Detection set up with Slack alerts
  • Monthly cost review cadence: agenda, dashboards, owners
Architecture Changes

What changed under the hood, and what didn't.

The architecture diagrams below show the meaningful changes. Note what stayed the same: multi-AZ deployment, KMS encryption, multi-region backups, ISO 27001 evidence collection. We never traded reliability for cost.

Before

Pre-engagement state

  • EC222 instances oversized vs Compute Optimizer
  • RDS3 instances at 4× capacity
  • EKSStatic cluster sized for peak
  • RIsMismatched portfolio, 18mo stale
  • NAT GW3 deployed, 1 sufficient
  • EBS5 orphan volumes
After

Post-engagement state

  • EC222 right-sized · 18 on Graviton
  • RDS3 Aurora instances right-sized
  • EKSKarpenter auto-scaling enabled
  • SP/RI70/20/10 portfolio rebalanced
  • NAT GWConsolidated 3 → 1 + VPC endpoints
  • FinOpsTags, dashboards, anomaly detection
Savings Breakdown

Where the $18k/month came from

Every saving below was validated against the AWS bill before the engagement closed. No projected savings, no estimated future benefits, only confirmed monthly cost reductions visible on the AWS invoice.

Optimization AreaMethodMonthly Saving
Reserved Instance / Savings Plan rebalanceSold mismatched RIs, bought Compute Savings Plans$6,500
EC2 right-sizing22 instances down-sized per Compute Optimizer$4,100
EKS rightsizing + KarpenterAuto-scaling vs static peak provisioning$3,000
Graviton migration18 instances moved to ARM-based instances$2,300
NAT Gateway consolidation3 → 1 NAT GW + VPC endpoints for AWS services$1,400
S3 Intelligent-Tiering3 largest buckets migrated to tiered storage$1,000
Idle resource cleanupUnattached EBS volumes, unused EIPs$530
RDS right-sizing3 Aurora instances down-sized$510
CloudWatch log retentionRetention rules + S3 archive policy$380
Other (small line items)Spot instance migration on dev/staging, etc.$610
Total Validated Monthly Saving$18,000

Monthly AWS Bill, 12 months

Pre-engagement
Post-engagement
Month -3
$46k
Month -2
$47k
Month -1
$47k
Month 1
$42k
Month 2
$37k
Month 3
$29k
Month 6
$30k
Month 12
$33k
Beyond The Bill

What changed, permanently.

The $18k/month is the headline number, but the real outcome is the lasting practice. The team now runs cost reviews monthly, catches anomalies within 24 hours, and treats cloud cost as an engineering KPI.

$

Validated cost reduction

Every saving was validated against the AWS bill before sign-off. No projected savings. The CFO confirmed the new run rate at the end of month 3.

−38% / month

Engineering velocity preserved

Deployment frequency, lead time for changes, and MTTR all remained within their pre-engagement bands. Cost optimization didn't slow the team.

0 regressions

FinOps culture installed

Per-team cost dashboards in Grafana, Cost Anomaly Detection routed to Slack, and a monthly cost review meeting between engineering and finance with a documented agenda.

Sustained 12+ months

Compliance posture maintained

ISO 27001:2022 evidence collection ran throughout. CloudTrail, multi-AZ, KMS, and Backup remained unchanged. No reduction in DR or audit capacity.

Audit-clean

We expected to save 15-20%. We saved 38%, with no reliability impact. The dashboards alone changed how our engineers think about deployments, that's the part we didn't see coming.

JM
Joanna M.CTO · UK HealthTech (anonymized)
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