Economic evaluation of anti-malarial drug policies across presidential regimes in Nigeria: A comparative analysis from 1999 to present

Background: Malaria remains a significant public health challenge in Nigeria, accounting for substantial morbidity, mortality, and economic loss. Successive administrations have implemented various anti-malarial drug policies aimed at curbing this endemic disease. This study applies a formal economic evaluation framework—integrating both cost-effectiveness analysis (CEA) and cost-benefit analysis (CBA)—to assess and compare anti-malarial drug policies across different presidential regimes. Methods: A comparative economic evaluation was conducted using incremental cost-effectiveness ratios (ICERs) and benefit-cost ratios (BCRs) derived from regime-specific expenditure and health outcome data. The study reviewed policy documents, drug procurement records, and health outcome data spanning multiple administrations from 1999 to the present. Costs were calculated based on drug procurement expenses, implementation costs, and healthcare savings from reduced malaria incidence. Effectiveness was measured by reductions in malaria morbidity and mortality, along with improvements in health-adjusted life years (HALYs). Analyses were conducted from both the healthcare system and societal perspectives, with all financial figures adjusted for inflation and purchasing power parity (PPP) to 2024 Naira equivalents. Results: The study found varying effectiveness and cost-efficiency across different administrations. During the 1999–2007 administration, the National Malaria Control Program (NMCP) had an implementation cost of ₦120 billion, leading to a 35% reduction in malaria prevalence and an ICER of ₦150,000 per HALY gained. The 2007–2010 administration saw a decrease in malaria control investment to ₦75 billion, resulting in only a 15% reduction in cases and a less favorable ICER of ₦220,000 per HALY. In 2010–2015, funding increased to ₦140 billion, achieving a 40% reduction in malaria cases and improving cost-effectiveness to ₦130,000 per HALY, corresponding to a BCR of 1.25. From 2015 to 2023, despite economic challenges, ₦200 billion was invested in expanding access to Artemisinin-based Combination Therapy (ACT), reducing malaria mortality by 20% and yielding a moderate ICER of ₦170,000 per HALY and a BCR of 1.10. Preliminary data from the 2023–present administration indicate an allocation of ₦220 billion, focusing on innovative financing models and domestic production of ACTs, with early results suggesting potential cost reductions to ₦160,000 per HALY and an estimated BCR of 1.30. Conclusion: The scientific evaluation demonstrates that while all regimes contributed to progress in malaria control, the degree of cost-effectiveness varied significantly based on policy focus, funding efficiency, and governance structure. Regimes that prioritized evidence-based drug policy and stable financing achieved superior health gains per Naira spent. This underscores the importance of data-driven, economically sustainable policy design to sustain malaria control achievements and improve population health outcomes in Nigeria.