📖 ABSTRACT/OVERVIEW
The National Health Insurance Scheme in Nigeria covers a limited range of outpatient pharmaceutical benefits, leaving a large proportion of medicine costs as out-of-pocket expenditures that impede access and drive catastrophic health spending. Expanding scheme coverage to include comprehensive pharmacy services, including medication therapy management, chronic disease refill programs, and pharmacist-led monitoring, requires robust economic modelling to inform policy investment decisions. This study modelled the cost-effectiveness of expanding National Health Insurance Scheme coverage to include defined pharmacy services across Nigeria using a decision-analytical Markov modelling approach. The analysis was conducted from the societal and health system perspectives over a 10-year time horizon. Model structure encompassed three common chronic disease states, namely hypertension, type 2 diabetes mellitus, and asthma, as index conditions. Transition probabilities, utility values, and resource use estimates were derived from systematic literature review, national health accounts, Nigerian clinical datasets, and expert elicitation. Cost inputs were sourced from National Health Insurance Scheme tariff schedules and primary costing studies. Incremental cost-effectiveness ratios were calculated and benchmarked against the Nigeria-specific willingness-to-pay threshold. Probabilistic sensitivity analysis assessed parameter uncertainty. Expanding pharmacy service coverage was found to be cost-effective for all three index conditions, with incremental cost-effectiveness ratios ranging from 8,200 to 14,600 naira per quality-adjusted life year gained. Estimated 10-year return on investment from reduced hospitalizations and disease complications was 3.2 to 4.7 times the program investment. These findings present a compelling economic case for National Health Insurance Scheme pharmacy service expansion as a high-value investment in Nigeria's universal health coverage agenda. Keywords: cost-effectiveness, National Health Insurance Scheme, pharmacy services, Markov modelling, universal health coverage
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