Developing Realist Economic Evaluation Methods (REEM) and Guidance to Evaluate the Effectiveness, Costs, and Benefits of Complex Interventions


This project was funded by the NIHR Health and Social Care Delivery Research programme (Award ID: NIHR135102). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.


About REE

  • Realist Economic Evaluation (REE) is a way of assessing and comparing complex interventions by looking at how they work, for whom, in which circumstances and at what cost.
  • REE was developed through a three-year funded National Institute for Health and Care Research (NIHR, project #135102).
  • Outputs from the research include guidance for REE and a graphic summary. The guidance describes, step by step, how to conduct a REE. The graphic summary gives a plain English overview of the REE guidance.

Join the REE Special Interest Group

If you’re conducting a Realist Evaluation incorporating economic factors, or an Economic Evaluation that is more theory-driven than usual, join our SIG.

http://www.jiscmail.ac.uk/realisteconomic

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Realist Economic Evaluation (REE) Guidance

The Realist Economic Evaluation (REE) guidance and accompanying graphic summary were developed during the REEM project and are available to download free of charge for non-commercial use.

Terms and conditions for use of both documents

  1. You grant permission to be followed up by Northumbria University to provide information to support evidencing of impact of the REEM research, its outputs and supporting materials including this guidance.
  2. You will not use the REEM research outputs and supporting materials including this guidance for profit-making purposes.
  3. You will refer to the REEM research outputs and supporting materials including this guidance by its title as stated on the Knowledge Bank platform when using and/or sharing.
  4. You will appropriately reference and credit Northumbria University and the creator(s) of the REEM research and supporting materials including this guidance when using and/or sharing.

Our team

Sonia Dalkin

co-Principal investigator

Professor in Applied Health and Social Care Research at Northumbria University; member of Fuse (centre for translational research in public health); co-leads Healthy Ageing Research Programme.

Sonia has significant experience in realist approaches. In 2018 she co-authored Doing Realist Research, published by Sage and, in the same year, launched the Northern Realist Research Team Hub (NoRTH). NoRTH comprises an experienced team of researchers based at Northumbria University with established regional, national and international links, who have expertise in and are regularly using and developing realist approaches to research.

Angela Bate

co-principal investigator

Professor in Health Economics with an international reputation in the development and application of health economic methods in complex (public health) evaluations.

Angela’s PhD utilised quantitative and qualitative research to interrogate approaches to primary care commissioning. Angela is actively involved in regional, national and international research organisations, including the Complex Systems research group; the National Institute for Health Research School for Public Health Research; the Social Value International Academic Research Group; and an associate member of Fuse.

Andrew Fletcher

Research fellow

Andrew’s PhD was a realist evaluation of interventions that use participatory music activities to increase wellbeing for people with mental health issues. He worked on the interdisciplinary philosophy/social science project, ‘Knowledge for Use’ at Durham University, then as an ethnographer at King’s College London. Also working on an NIHR ARC-funded whole systems evaluation of knowledge equality in the housing sector.

Andrew is particularly interested in qualitative and participatory methods, and epistemic (in)justice in health systems. Associate member of Fuse; freelance copywriter; plays the bass guitar.

Meghan Kumar

co-investigator

Meghan is a health economist and health systems researcher focusing on implementation research in low-resource settings. Methodologically, she works on economic evaluation in complex systems, policy and political economy analysis, and participatory approaches to research and systems change. Her research direction involves incorporating participatory and economic evaluation methods to improve social inclusion toward multi-level accountability in global health.

Geoff Wong

co-investigator

Associate Professor of Primary Care at the Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.

Experienced realist reviewer and evaluator; led the development of the RAMESES quality and reporting standards and training materials for realist reviews and realist evaluations (www.ramesesproject.org). Also a part time General Practitioner in the NHS.

Judy Wright

co-investigator

Information Specialist team leader at Leeds Institute of Health Sciences (LIHS); chartered librarian; supports the management of the Academic Unit of Health Economics (AUHE).

Portfolio includes: custom-made literature searching, reference management and search methodology advice for systematic reviews, realist reviews, evidence syntheses, research proposal scoping, economic evaluations and cost-effectiveness models.

Cam Donaldson

co-investigator

Yunus Chair and Distinguished Professor of Health Economics at Glasgow Caledonian University.

Cam previously held the Health Foundation Chair at Newcastle University, the Svare Chair at University of Calgary and a professorship at the University of Aberdeen. The basis for Cam’s interest in REEM stems from his previous research on developing methods for priority setting and economic evaluation in health and health care.

Gill Westhorp

co-investigator

Specialist in realist research and evaluation methodologies. Professorial Research Fellow at Charles Darwin University, Australia, leading the Realist Research Evaluation and Learning Initiative (RREALI).

Gill is co-author of the international publication standards and quality standards for realist evaluation and realist literature review. She has led, undertaken or advised over 70 research and evaluation projects in diverse sectors, and provided in excess of 70 training workshops in 14 countries. She develops new methods for realist research and evaluation, and publishes in realist methodologies.

Rachel Baker

co-investigator

Director, Yunus Centre for Social Business and Health; Professor of Health Economics. Focusses on the use of mixed methods to: i) elicit societal values with respect to resource allocation for health and ii) study the benefits arising from policies, programmes or interventions that impact on health and wellbeing.

Investigating how society values different uses of public resources and how community-based organisations generate impact for participants. Expertise in health economic approaches to valuation and preference elicitation, Q methodology, and Q-based survey methods.

Rob Anderson

co-investigator

Health services researcher, economic evaluator and implementation science scholar. Interested in the evaluation and synthesis of evidence about health policies and complex health interventions; systematic reviews and evidence synthesis for policymaking (especially theory-driven approaches); implementation Science and Knowledge Mobilisation/Translation.

Director, ESMI research group; Director of Research Impact for Exeter University Medical School’s Institute of Health Research; Co-leads the Exeter HS&DR Evidence Synthesis Centre.

Felicity Shenton

ppie co-lead

Public Involvement & Community Engagement Manager, NIHR Applied Research Collaboration NENC.

Qualified social worker; managed an alternative to custody project; freelance trainer/researcher/project development manager and policy adviser. Strategic Director of Investing in Children until 2017, then Programme Manager of the North East Social Work Alliance. PhD was a co-produced participatory research project with young people in secure accommodation.

Vivienne Hibberd

ppie co-lead

Vivienne has a background in Student Support and Well-being, and Widening Participation in higher education, as well as advocacy in mental health.

She has recent experience in PPIE in health and social care research projects, including study design, chairing meetings and project management.

International Interdisciplinary Advisory Group

Professor Hareth Al-Janabi, Professor Andy Briggs, Professor Heather Brown, Professor Jo Coast, Professor Neil Craig, Professor Simon Feeny, Dr Brynne Gilmore, Professor Joanne Greenhalgh, Dr Robert Heggie, Dr Rebecca Hunter, Professor Bruno Marchal, Dr Tomasina Oh, Professor Catherine Pitt, Dr Catherine Purcell, Dr Jack Rendall, Professor Tracey Sach, Dr Katie Shearn, Emeritus Professor Nick Tilley.


REE-relevant media

27th June 2025

Professor Gill Westhorp discusses Formal theory in realist research and evaluation

6th June 2023

Professor Nick Tilley discusses EMMIE: tenses and tensions in meeting evaluation needs