Public Pricing Research Articles

$$\lambda $$ envy-free pricing for impure public good

In this paper, we examine the provision and pricing of an excludable public good with congestion under lump-sum tax/transfer, constrained by the reduction of envy. We adopt the $$\lambda $$ envy-free constraint as a weaker equity concept of no-envy and characterize the optimal public sector pricing rule depending on envy reduction concerns, which is different from the pricing rule contingent on utilitarian distributive concerns. We find that the two fairness concerns are countervailing with regard to the surcharge fee.

Welfare effects of carbon taxation on South African households

This paper evaluates the welfare impacts of carbon taxation on South African households. Using household survey data for the period 2009–2015, I estimate the Quadratic Almost Ideal Demand System (QUAIDS) model to obtain elasticities and use them to simulate consumer responses to price changes resulting from carbon taxation. Results show that an increase in electricity and public transport prices following a carbon tax policy is regressive while a price increase in motor fuel is progressive. In addition, when there is a simultaneous increase in the prices of energy goods, the poorest and middle income households disproportionately suffer a higher welfare loss compared to the richest households. I also show that income is important in determining whether rural households experience a higher or lower welfare loss than urban households. Furthermore, revenue recycling in terms of lump-sum transfers of the tax revenue to households below the national poverty lines and the bottom 40% would offset the welfare loss from a carbon tax policy in South Africa.

Rhetoric or Reality: Are Health Systems Redesigning How Health Care Is Delivered?

Despite strong evidence about deficiencies in quality and safety, and abundant rhetoric about moving from volume‐based to value‐based care, to date, little systematic research has examined whether and how health systems are reengineering the way health care is organized and delivered. We adopt the term care delivery redesign (CDR) to capture the variety of tools and organizational change processes used by health systems to pursue the Triple Aim. We answer the following research questions.Are health systems motivated to engage in CDR? What factors are driving these efforts?What CDR strategies and activities are health systems using?Key informant interviews with 162 executives in 24 health systems as part of the Agency for Healthcare Research and Quality’s Comparative Health System Performance Initiative. Interviews were audio‐recorded and transcribed, and global codes were applied using the Dedoose qualitative software based on a systematic codebook developed by the study team. Study investigators and analysts reviewed transcripts and coded text to arrive at study findings using a team‐based qualitative analytic approach.Purposive sample of health systems in four states (California, Minnesota, Washington, and Wisconsin). Health systems in each state were selected to provide variation across a number of dimensions including size, profit status, geography served, and financial condition.We report seven motivating factors reported by health systems for engaging in CDR, including intrinsic factors (organizational priorities; organizational culture; fiscal health) and extrinsic factors (public policy and price and quality transparency, alternative payment models, community and population needs, current scientific guidelines). We also present and discuss five categories of CDR activities health systems are pursuing (consistency and efficiency of care; care coordination and management; consumer‐centric care; patient in environment; and evidence, data, analytics, and technology). We provide specific examples of each area and use case examples to qualitatively illustrate the variation across systems in both motivating factors and CDR activities).The breadth and depth of CDR activities in our health system sample varied. Systems with executives who reported having strong intrinsic motivation for their efforts appear to be on a more well‐defined path than systems with executives who report strong extrinsic motivation. Health systems are engaging in a wide range of activities, with some systems focusing only on small‐scale or incremental changes and others focusing on a broad range of activities that fit within a larger vision of CDR. The variation that exists on CDR activities may be useful for developing a systematic measurement approach for CDR activity in a broader sample of health systems.Currently, researchers are not able to validly and reliably measure CDR activities, preventing quantification of the impact these activities have on the Triple Aim outcomes.Agency for Healthcare Research and Quality.

Health Care Costs Associated to Type of Feeding in the First Year of Life.

Background: Breastfeeding is associated with lower risk of infectious diseases, leading to fewer hospital admissions and pediatrician consultations. It is cost saving for the health care system, however, it is not usually estimated from actual cohorts but via simulation studies. Methods: A cohort of 970 children was followed-up for twelve months. Data on mother characteristics, pregnancy, delivery and neonate characteristics were obtained from medical records. The type of neonate feeding at discharge, 2, 4, 6, 9 and 12 months of life was reported by the mothers. Infectious diseases diagnosed in the first year of life, hospital admissions, primary care and emergency room consultations and drug treatments were obtained from neonate medical records. Health care costs were attributed using public prices and All Patients Refined–Diagnosis Related Groups (APR–DRG) classification. Results: Health care costs in the first year of life were higher in children artificially fed than in those breastfed (1339.5€, 95% confidence interval (CI): 903.0–1775.0 for artificially fed vs. 443.5€, 95% CI: 193.7–694.0 for breastfed). The breakdown of costs also shows differences in primary care consultations (295.7€ for formula fed children vs. 197.9€ for breastfed children), emergency room consultations (260.1€ for artificially fed children vs. 196.2€ for breastfed children) and hospital admissions (791.6€ for artificially fed children vs. 86.9€ for breastfed children). Conclusions: Children artificially fed brought about more health care costs related to infectious diseases than those exclusively breastfed or mixed breastfed. Excess costs were caused in hospital admissions, primary care consultations, emergency room consultations and drug consumption.

개별공시지가를 활용한 공동주택가격의 지역별 형평성 검증 연구

This study analyzes the regional equity of the multi-unit house price disclosure system in order to contribute to the improvement of the real estate price disclosure system. For equity analysis, we analysis the mutual causality of the multi-unit house price and the individual public land price, which are the core of the current real estate price disclosure system. First, three hypotheses are set by investigating and analyzing prior studies and preparing research models. In order to prove the hypothesis, the study created a hedonic price model using information on the nationwide multi-unit house price announced by the Ministry of Land, Infrastructure and Transport for 2019, individual land prices, and column for title of building register. Last, Based on the model, the hypothesis was verified and the implications according to the verification results were summarized. Among the hypotheses, the first hypothesis was adopted that regional factors and individual building factors would affect the price of multi-unit houses by region. And The second hypothesis that the effect of regional factors and individual building factors on multi-unit house prices will be differentiated by region was also adopted. At the same time, the possibility of regional differentiation was also discovered. The third hypothesis that the ratio of the influence of regional factors and individual building factors on the price of multi-family houses will be component ratio of land and building was rejected. In the end, it was estimated that there is a high possibility that regional imbalances are inherent in the public noticed system of multi-unit house price.

An evaluation of managed entry agreements in Belgium: A system with threats and (high) potential if properly applied

ObjectiveTo evaluate the strengths and weaknesses of managed entry agreements (MEAs) in Belgium. MethodsAll Belgian MEAs signed between 2010 and 2015 (n = 71) were studied, including the re-evaluations of 16 reimbursement requests for which the initial MEA had ended. The analysis was supported by the findings from a systematic literature review and structured interviews with Belgian stakeholders. ResultsThe current application of MEAs provides the short-term advantage of getting a positive reimbursement decision with lower confidential prices. However, it is not clear whether the negotiated prices are in line with the added value of the interventions. Furthermore, the contracts do not provide incentives for manufacturers to gather evidence or to set public prices at an acceptable level. ConclusionsBased on our analysis of the Belgian MEAs and discussions with Belgian stakeholders, an overview of various issues and pitfalls related to the current application of the system is given. Recommendations are made related to providing correct incentives to deliver good evidence, establishing a correct link between identified uncertainties/problems and the type and content of the MEA, reducing the risk of making the system non-transparent, the importance of international collaboration, etc. in order to optimize the potential of this system. These recommendations are addressed to both the Belgian policymakers and stakeholders in other countries making use of MEAs.

Greening the Post-pandemic Recovery in the G20

Rebuilding G20 economies after the COVID-19 pandemic requires rethinking what type of economy we need and want in the future. Simply reviving the existing ‘brown’ economy will exacerbate irreversible climate change and other environmental risks. For G20 economies, investing in a workable and affordable green transition is essential. A good place to start is learning what worked and what did not from previous efforts to green the economic recovery during the 2008–2009 Great Recession, examining the cases of the United States and South Korea. Policies for a sustained economic recovery amount to much more than just short-term fiscal stimulus. Transitioning from fossil fuels to a sustainable low-carbon economy will require long-term commitments (5–10 years) of public spending and pricing reforms. The priorities for public spending include support for private sector green innovation and infrastructure, development of smart grids, transport systems, charging station networks, and sustainable cities. Pricing carbon and pollution, and removing fossil-fuel subsidies, can accelerate the transition, raise revenues for the necessary public investments, and lower the overall cost of the green transition.

Economic and distributional effects of different fare schemes: Evidence from the Metropolitan Region of Barcelona

• Individuals are more sensitive to changes in quality than in prices. • Subsidies have a moderate progressive effect explained by the higher use of public transport by low-income groups. • Changing the fare structure has a relatively small effect on modal-split, while the effect on revenue can be higher. • The distributional profiles of alternative pricing strategies are very similar. • Suppressing the integrated fare system has a regressive effect but of limited magnitude. This paper assesses the ability of alternative fare system designs to change the modal-share of public transport use, as well as their corresponding impact on company revenues. Specifically, we provide evidence for how switching from flat to distance fares or from integrated to non-integrated tickets affects both the ridership and the financial situation of public transport companies. Secondly, because distributional concerns are at the heart of the policy debate, we evaluate the impact of the alternative fare schemes on equity. We distinguish between commuting and personal travel purposes. Focusing on the Metropolitan Region of Barcelona, our analysis shows that different pricing structures have only a moderate effect on ridership, while the potential for revenue changes is higher. Regarding equity, our results reveal that the distributional profiles of alternative pricing strategies are quite homogeneous. However, there appears to be a mild regressive effect when an integrated fare system is removed. Our results may help to guide policy decisions related to public transport pricing strategies.

How well does Malaysia achieve value for money in public sector purchasing of medicines? Evidence from medicines procurement prices from 2010 to 2014

BackgroundMalaysia’s public healthcare sector provides a greater volume of medicines at lower overall cost compared to the private sector, indicating its importance in providing access to medicines for Malaysians. However, the Ministry of Health (MOH) has concerns about the continuous increase in the public sector medicines budget, and achieving efficiencies in medicines procurement is an important goal. The objectives of this study were to assess the overall trend in public sector pharmaceutical procurement efficiency from 2010 to 2014, and determine if the three different ways in which MOH procures medicines influence efficiency.MethodsWe matched medicines from the public sector procurement report by medicine formulation to medicines with a Management Sciences for Health (MSH) International Reference Price (IRP) for each year. Price ratios were calculated, and utilizing the information on quantity and expenditure for each product, summary measures of procurement efficiency were reported as quantity- and expenditure-weighted average price ratios (WAPRs) for each year. Utilizing MOH procurement data to obtain information on procurement type, a multiple regression analysis, controlling for factors that can influence prices, assessed whether procured efficiency (relative to IRPs) differed by MOH procurement type.ResultsMalaysia’s public sector purchased medicines at two to three times the IRP throughout the study period. However, procurement prices were relatively stable in terms of WAPRs each year (2.2 and 3.2 in 2010 to 1.9 and 2.9 in 2014 for quantity and expenditure WAPRs, respectively). Procurement efficiency did not vary between the three different methods of MOH procurement. Procurement efficiency of both imported originators and imported generics were significantly lower (P < 0.001 and P < 0.01) than local generic products, and medicine source and category influenced the procurement efficiency of each MOH procurement mechanism.ConclusionThe design of different medicines procurement mechanisms, along with the balance between ensuring competitive procurement prices and adhering to national industry and procurement policies, have not been able to achieve lower public sector medicines procurement prices (relative to IRP). Introducing pooled procurement options along with continuous monitoring of procurement efficiency and exploring ways to improve price competition among local and foreign suppliers is recommended.

Cost of fremanezumab, erenumab, galcanezumab and onabotulinumtoxinA associated adverse events, for migraine prophylaxis in Spain

ABSTRACT Objective: To compare the cost of adverse events (AEs) associated with preventive treatment of migraine with fremanezumab, versus erenumab, galcanezumab, and onabotulinumtoxinA. Methods: A probabilistic modeling analysis was performed, using second-order Monte Carlo simulations, with 1,000 simulations, in patients with at least 4 days of migraine per month, from the perspective of the National Health System and a time horizon of 12 weeks. The frequency of AEs described in the clinical trials was analyzed with 12 weeks of treatment. Unit costs (€) of management of AEs were obtained from public health prices, expert panels, and published Spanish studies. Results: Fremanezumab would generate average savings of -€469 (95% CI -€303; -€674) versus erenumab, -€268 (95% CI -€171; -€391) versus galcanezumab, -€1,100 (95% CI -€704; -€1,608) or -€1,295 (95% CI -€835; -€1,893) versus onabotulinumtoxinA using real-life or clinical trial data, respectively. Conclusions: The different safety profile of treatment with fremanezumab, compared to erenumab, galcanezumab, and onabotulinumtoxinA, would generate savings in health-care resources in all the scenarios considered.

Cost and potential savings generated by a paediatrics e-Health web site for parents

There are few studies on e-Health interventions directed at parents that analyse their costs and any potential savings that may occur. The aims of this study consisted of calculating the costs of the development and maintenance of paediatric web site for parents, including the costs per visit and per visitor, and the potentially savings made as regards medical visits avoided as a result of its use. The technology costs as well as the work of the professionals were considered as costs of the web site. The calculation of the cost of the professionals and the potential savings were based on the official fees and public prices of the Andalusian Public Health Service. During 5years and 6months of the study, the total cost of the web site was €45,201.56. The cost per visit received was €0.0155€, and €0.0186 for each single visitor. Among the 516 users that took part in the study, face-to-face visits to Primary Care paediatric clinics were avoided, as well as those to Paediatric Emergency Department, at a savings of €22,263.89. The costs of developing a paediatric e-Health website for parents written in Spanish, using existing and free technologies, are low compared to other forms of e-Health development. Furthermore, the costs are considerably low if they are divided by the total number of visits or the number of visitors. There is also a considerable potential financial saving on contributing to avoid face-to-face visits.

Affording Immune Checkpoint Inhibitors (ICI) in the treatment of advanced non-small cell lung cancer (NSCLC): Argentinean National Cancer Institute (ANCI) perspective.

e19404 Background: ICI agents proved clinical effectiveness in metastatic NSCLC; irrespectively PDL1 expression, but they increase costs considerably. Thus its cost-effectiveness (CE) needs to be established in low and middle-income countries. We aimed to assess CE of Pembrolizumab plus carboplatin and pemetrexed (PCP) vs. carboplatin and pemetrexed (CP) in the first-line setting for non-squamous NSCLC, according to PDL1expresion, in Argentinian public healthcare system (APHS). Methods: Clinical outcomes, utilities, and transition probabilities were collected from the available literature (Keynote 189/024) after a systematic review. The certainty of evidence according to GRADE methodology was qualified as high. A Markov model was developed. Model outcomes were measured in quality adjusted-life-years (QALY) and CE was estimated as the incremental cost-effectiveness ratio (ICER) over a 20 years time horizon. Only direct costs were considered from a public price database of the drugs accounted in the model. The WHO ICER threshold, defined as 1-3 GDP per capita, was selected to established CE. Sensitivity analyses were performed to assess the robustness of results. Results: In PDL1≥ 50 % subgroup, PCP increased life expectancy of patients by 1.06 QALY for an incremental cost of USD 71.551 vs. CP with an ICER of 67.352 per QALY. An indirect comparison of PCP vs. Pembolizumab monotherapy found no differences in QALY estimates, however, it was associated with an incremental cost of USD 5.516. QALY estimate for PDL1 1-49% was 0.73 with an ICER of USD 85.984/ QALY gained. PDL1 &lt; 1% obtained a QALY of 0.42 related to the largest ICER (USD 97.095) for the same comparison. The sensitivity analyses using a threshold between 1- 3 Argentinian GDP per capita in 2018 (USD 11.8602) found that PCP has no chance of being considered CE in untreated NSCLC patients. If a 6 GDP threshold is adopted in PDL1≥ 50 %, PCP would have a 50% possibility of being CE. Conclusions: This model was part of the decision-making process in the development of treatment guidelines for metastatic NSCLC in the ANCI. PCP cannot be considered acceptable for the APHS. Strategies to reduce costs are mandatory to improve affordability in our region.

Asymmetric information in the German intraday electricity market

This paper investigates how private and public information about unplanned power plant outages impact intraday electricity prices in Germany. It uses data from the EPEX day-ahead and continuous intraday markets as well as market messages concerning unscheduled power plant non-usabilities from the European Energy Exchange (EEX) transparency platform. The results of an econometric analysis suggest that private and public information about unplanned power plant outages have a significant positive effect on the intraday price. Furthermore, this paper shows that a reduction of the lead time on the intraday market enhances the possibilities of traders reacting to unplanned non-usabilities: an increased impact of private information on the electricity price is observed. The results also confirm an asymmetric impact of private and public information on the intraday price after the lead time reduction on the power exchange. The findings contradict the main objectives of the Regulation on Wholesale Energy Market Integrity and Transparency (REMIT), which stipulates that the possession of private information must not have an impact on electricity prices. • We analyze how private and public information impact intraday electricity prices. • We use messages from the European Energy Exchange (EEX) transparency platform. • The results suggest an asymmetric impact of information about unplanned outages. • The findings contradict the main objectives of REMIT.

PND67 COMPARISON OF MULTIPLE SCLEROSIS DRUG PRICES IN SAUDI ARABIA VS. UNITED ARAB OF EMIRATES.

This study assessed the difference in patient access and public prices (PP) of multiple sclerosis (MS) disease modifying therapies (DMTs) marketed in Saudi Arabia (SA) vs. United Arab of Emirates (UAE).

PCN166 IMPACT OF COLORECTAL CANCER SCREENING IN THE FRAMEWORK OF UNIVERSAL HEALTH COVERAGE (UHC)

Estimate the health impact and the economic costs of the implementation of screening for CRC with fecal occult blood test in the Argentine public health system Markov model that simulates the evolution in 50 years of a population cohort exposed to the risk of developing CRC in two analysis scenarios: “IFOBT screening” and “Non-existence of screening”. The natural history of the disease was simulated by ten health states based on information from scientific publications. The medical costs associated with the detection and treatment of polyps and cancer were estimated using public bidding prices from the Ministry of Health.The time horizon is 50 years and a 3% annual discount rate is used for costs and outcomes measured in QALYs. According to our simulation, during the first five years of the screening implementation, an increase in the CRC incidence is observed. Reached the tenth year of implementation, the number of high-risk polyps and cases of CRC decrease by 40% and 50% respectively. In turn, the decrease in the risk of dying from CRC for people who participate in screening is 28%. Finally, the screening strategy with TiSOMF is an effective cost since the cost per AVAC of the intervention is USD 349 (incremental cost USD 120 and incremental AVAC 0.35), while the Argentine GDP per capita in dollars for the year 2018 was USD 11,645, that is, the RCEI is sufficiently lower than the national GDP per capita (0.03 GDP PC). The implementation of screening with IFOBT is a cost effective intervention compared to the current situation.In the screening scenario, 90% of the expenditure is destined to the treatment of advanced CRC, while in the scenario with the same proportion, it is allocated to instances of prevention and early detection with an impact on hope and quality of life.

Una alternativa progresiva a la estructura lineal de precios públicos en la financiación del sistema universitario en España

Este trabajo analiza los principales cambios que se han introducido recientemente en la financiación del Sistema Universitario Español. El objetivo es, por una parte, revisar las consecuencias derivadas de estas medidas en términos de suficiencia y equidad y, por otra, estudiar la viabilidad de aplicar un sistema progresivo en el cobro de precios públicos, teniendo en cuenta el origen económico del estudiante. Las conclusiones evidencian que la introducción de un sistema de este tipo sería compatible con los principios de suficiencia y de equidad, y viable en su aplicación. Sin embargo, se requieren algunas precauciones para que los efectos en recaudación, progresividad y redistribución tengan el resultado perseguido.

Exploring differences between private and public prices in the English care homes market.

This work quantitatively assesses the potential reasons behind the difference in prices paid by care home residents in England. Evidence suggests that the price paid by private payers is higher than that paid for publicly supported residents, and this is often attributed to the market power wielded by local authorities as the dominant purchaser in local markets. Estimations of private prices at the local authority level are used to assess the difference in price paid between private and public prices, the fees gap, using data from 2008 to 2010. Controlling for local area and average care home characteristics, the results indicate that both care home and local authority market power play a role in the price determination of the market.

Cost-effectiveness of Tisagenlecleucel vs Standard Care in High-risk Relapsed Pediatric Acute Lymphoblastic Leukemia in Canada

Tisagenlecleucel, a chimeric antigen receptor T-cell therapy for relapsed or refractory pediatric acute lymphoblastic leukemia, has been approved for use in multiple jurisdictions. The public list price is US $475 000, or more than CaD $600 000. Assessing the cost-effectiveness of tisagenlecleucel is necessary to inform policy makers on the economic value of this treatment. To assess the value for money of tisagenlecleucel compared with current standard care for tisagenlecleucel-eligible pediatric patients with acute lymphoblastic leukemia under unknown long-term effectiveness. A cost-utility analysis of tisagenlecleucel compared with current standard care using a Canadian population-based registry of pediatric patients with acute lymphoblastic leukemia was performed. Results from 3 pooled single-arm tisagenlecleucel clinical trials and a provincial pediatric cancer registry were combined to create treatment and control arms, respectively. The population-based control arm consisted of patients meeting clinical trial inclusion and exclusion criteria, starting at second relapse. Multistate and individual-level simulation modeling were combined to predict patient lifetime health trajectories by treatment strategy. Tisagenlecleucel efficacy was modeled across long-term cure rates, from 10% to 40%, to account for limited information on its long-term effectiveness. Uncertainty was tested with 1-way and probabilistic sensitivity analysis. Data were collected in September 2017, and analysis began in December 2017. Tisagenlecleucel compared with current standard care for tisagenlecleucel-eligible patients. Relative health care costs, survival gains, and quality-adjusted life-years (QALYs) between tisagenlecleucel and current standard care. The treatment and control arms were modeled on 192 and 118 patients, respectively. The mean (SD) age of control individuals was 10 (4.25) years, and the mean (SD) age of the pooled clinical trial sample was 11 (6) years. The control individuals had 78 boys (66%), and the pooled clinical trial sample had 102 boys (53%). Treatment with tisagenlecleucel was associated with an additional 2.14 to 9.85 life years or 1.68 to 6.61 QALYs, compared with current care. The average additional cost of tisagenlecleucel was CaD $470 013 (US $357 031). Accounting for the total discounted cost over the patient lifetime resulted in an incremental cost of CaD $71 000 (US $53 933) to CaD $281 000 (US $213 453) per QALY gain. To our knowledge, this study offers the first cost-effectiveness analysis of tisagenlecleucel compared with current standard care for pediatric patients with acute lymphoblastic leukemia using a constructed population-based control arm. At a willingness-to-pay threshold of $150 000/QALY, tisagenlecleucel had a 32% likelihood of being cost-effective. Tisagenlecleucel cost-effectiveness would fall below $50 000/QALY with a long-term cure rate of over 0.40 or a price discount of 49% at its currently known effectiveness.

Formaldehyde and Total VOC (TVOC) Commercial Low-Cost Monitoring Devices: From an Evaluation in Controlled Conditions to a Use Case Application in a Real Building

Formaldehyde and volatile organic compounds (VOCs) are major indoor pollutants with multiple origins. Standard methods exist to measure them that require analytical expertise and provide, at best, an average value of their concentrations. There is a need to monitor them continuously during periods of several days, weeks, or even months. Recently, portable devices have become available. Two categories of portable devices are considered in this research paper: connected objects for the general public (price &lt;500 €) and monitoring portable devices for professional users (price in the range &gt;500 to 5000 €). The ISO method (ISO 16000-29) describes the standard for VOC detector qualification. It is quite complex and is not well adapted for a first qualitative evaluation of these low-cost devices. In this paper, we present an experimental methodology used to evaluate commercial devices that monitor formaldehyde and/or total volatile organic compounds (TVOC) under controlled conditions (23 °C, 50–65% relative humidity (RH)). We conclude that none of the connected objects dedicated to the general public can provide reliable data in the conditions tested, not even for a qualitative evaluation. For formaldehyde monitoring, we obtained some promising results with a portable device dedicated to professional users. In this paper, we illustrate, with a real test case in an office building, how this device was used for a comparative analysis.

Measuring Availability and Prices of Locally Produced and Imported Medicines in Sudan

Introduction The objective of this study was to compare the availability and prices of locally produced and imported medicines, in particular after one year from medicines importation restriction and to answer the key questions, did local manufacturers able to coverage national needs of medicines and what is the patient prices for locally produced compared to imported medicines in different sectors and regions of Sudan. Methodology The WHO/HAI methodology survey tool was adapted to measure the availability and price of locally produced and imported medicines. Patient price and availability were collected from capital cities of 6 states as per WHO/HAI methodology. Data were collected and analyzed for 50 medicines from the 104 medicines restricted to local manufacturer. Availability was based on whether the medicine was in stock on the day of data collection at the surveyed facility. Prices were expressed as median price ratio (MPR). Results Availability of locally manufactured medicines (LMM) was much better than imported medicines (IM), in the public, (47.2% vs. 14%, respectively) and private (63.9% vs. 23.5%, respectively) sectors. Based on median price ratio (MPR), public sector patient prices for locally manufactured medicines were lowered priced and had a median MPR of 2.4 (n=42) than imported medicines which had a median MPR of 4.99 (n=20). In private sector patient prices for locally manufactured medicines were also lowered priced and had a median MPR of 2.76 (n=45) than imported medicines which had a median MPR of 5.53 (n=27). Thus; patients were paying about 52% less for locally produced than for imported medicines in both sectors Conclusion The survey showed low availability of the basket of medicines surveyed in the public and private sectors for imported medicines (I.M), while not achieving WHO’s target of 80 % for locally manufactured medicines (LMM). In developing countries a lot of barriers are well known to business and industrial need to be resolved in order to maintain availability and self-reliance in drug production as a mean of increasing access to medicines.