Economic evaluation guidelines in the Middle East and North Africa (MENA) region: a comparative analysis

Background Countries in the Middle East and North Africa (MENA) face increasing pressure to optimise healthcare spending through evidence-based decision making. Economic evaluation guidelines (EEGs) are key policy tools that standardise the conduct and reporting of health economic analyses and inform reimbursement decisions. This study systematically compares national EEGs across MENA countries using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) framework. Methods A systematic search was conducted to identify national EEGs in the MENA region. Primary sources included the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) repository and the Guide to Economic Analysis and Research (GEAR), supplemented by searches of bibliographic databases and grey literature. Extracted data were mapped against CHEERS checklist domains and supplemented with information on guideline scope, methodological requirements, and implementation status. Results Four national EEGs were identified for Saudi Arabia, Egypt, Lebanon, and Tunisia, published between 2015 and 2025. Three were mandatory, while the Egyptian guideline was advisory. All guidelines required clear definition of target populations, comparator selection, appropriate time horizons, and evidence on effectiveness. However, substantial variation was observed in model structure, handling of uncertainty, perspective, costing approaches, and decision thresholds. The Saudi and Tunisian guidelines showed closer alignment with CHEERS domains, particularly in model transparency and sensitivity analysis requirements. Conclusions EEGs in the MENA region differ considerably in methodological detail, enforcement, and institutional maturity, reflecting uneven development of health technology assessment systems. Harmonisation efforts should focus on core methodological standards while allowing contextual adaptation to national health system priorities.