Developing initial programme theory for realist economic evaluation: A review of findings from three pilot studies

It is increasingly recognised that ‘big problems’ in health and social care require well-designed solutions and robust evaluation, including attention to costs as well as outcomes. This is especially important in the pervasive environment of resource scarcity. Decisions need to be made that consider not only whether and how an intervention works but also affordability and efficiency in different circumstances and populations. As researchers tackle these complex issues, interest in bringing together realist and economic evaluation is growing. Responding to this, we discuss how using programme theory within a novel realist economic evaluation approach can be used in articulating how interventions may (or may not) bring about cost-effective change. We identify what initial programme theory in realist economic evaluation might look like in practice, drawing on data from three pilot realist economic evaluation studies.