Developing an Original Pharmacoeconomic Framework for Medicines Prioritisation in Nigeria’s National Health Insurance Authority Benefit Package

Rational medicines prioritisation in Nigeria's National Health Insurance Authority benefit package requires a pharmacoeconomic framework that integrates cost-effectiveness analysis, budget impact modelling, and equity considerations in a manner tailored to Nigeria's health system financing realities. This study developed an original pharmacoeconomic framework for medicines prioritisation applicable to NHIA benefit package design in Nigeria. A multi-component framework development methodology was employed, comprising systematic review of health technology assessment frameworks from comparable middle-income country contexts (Ghana NHIA, Kenya's NHIF, and Thailand's NICE analogue), stakeholder consultations with 40 health economists, pharmacists, clinicians, and NHIA policy officers, an original cost-effectiveness threshold analysis using willingness-to-pay anchoring in Nigerian GDP per capita, and pilot application of the framework to three therapeutic areas: malaria treatment, antihypertensives, and insulin products. The original Nigerian Medicines Prioritisation Framework (NMPF) encompasses five sequential evaluation modules: disease burden and unmet need assessment, clinical effectiveness and safety evidence synthesis, cost-effectiveness analysis using locally calibrated health economic models, budget impact projection using NHIA enrolment projections, and equity weighting for priority populations. The NMPF was applied to 18 candidate medicines, generating evidence-based prioritisation rankings validated by expert panel review. An original cost-effectiveness threshold of 1.5x Nigerian GDP per QALY was established and justified. The NMPF constitutes an original contribution to health technology assessment science in West Africa and provides an operational tool for NHIA essential medicines list design.

Keywords: pharmacoeconomics, health technology assessment, NHIA, medicines prioritisation, Nigeria