Realist methods in economic evaluation: Unravelling what is cost-effective, for whom, in what context and why

Colleagues from LSHTM and Northumbria University stand in front of a sign that reads the London School of Hygiene & Tropical Medicine

In the complex landscape of health policy and social interventions, realist methods have made an impact for answering not just whether interventions work, but who really benefits, under what specific conditions they succeed and throw light on how the interventions work in practice. A recent 'focus fortnight' at the London School of Hygiene & Tropical Medicine (LSHTM), involved colleagues from Northumbria University, Professors Sonia Dalkin and Angela Bate, Dr Meghan Kumar and Dr Sam Redgate, who spent their first week of the fortnight interacting with researchers at LSHTM who have a particular interest in realist methods and health economic evaluation.

Based on the original Focus Fortnight initiative started by Professor Tony O’Hagan at the University of Sheffield, Focus Fortnight invites an academic guest from another institution to spend a fortnight focusing on a problem of mutual interest between the guest and members of the Global Health Economics Centre (GHECO).

An inception seminar was held on Tuesday 16 April and was well attended by colleagues at GHECO and the Centre for Evaluation. Our colleagues in Northumbria led the session with an opening presentation that focused on Realist Economic Evaluation Methods (REEM), discussing previous and ongoing research to explore the rationale for integrating these methods and guidance for their use. The REEM project the team are leading has produced a set of draft guidelines which can be downloaded from the project website

This session was followed by wider discussion among participants. In particular, we heard from Professor Carl May who, while not classifying himself as a realist, nevertheless supported the concept of theory-driven research and welcomed the idea that all those involved in the evaluation of a process or intervention should do so in a joined up way.

Professor Chris Bonnell also spent time with our guests to discuss his own take on realist research, sometimes at odds with those in the realist community. Chris recently published a book on ‘Realist Trials and Systematic Reviews’ which was launched at LSHTM in March 2024.

GHECO welcome opportunities for colleagues from other institutes to get in touch about our recent focus fortnight event or possible opportunities for future collaboration. 

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