Saving money and lives: The impact of MPP

Estimating the impact of our work:

uptake, economics, and public health

With billions of doses of treatments supplied through access-oriented voluntary licensing since 2010, the Medicines Patent Pool (MPP) has had tremendous impact.

Until 2020, MPP reported its impact mostly in terms of economic savings, based on a methodology published in 2017 as a peer-reviewed article in PLOS One. Building from this model, and recognising the health benefits of accessing optimal treatments (compared to other, sometimes suboptimal alternatives), our impact assessment methodology now includes new health impact indicators, while being informed by more nuanced assumptions that help support credible estimations. The MPP impact assessment methodology was revised with technical support from Cambridge Economic Policy Associates (CEPA) and funding from Unitaid. The methodology was published in The Lancet Public Health in 2021 in a research article entitled The economic and public health impact of intellectual property licensing of medicines for low-income and middle-income countries: a modelling study. The article included two case studies and a detailed appendix providing additional details on the approach, the types of assumptions made and the kind of results obtained.

Today, our impact assessment methodology considers the role of MPP licences in supporting expanded generic competition and the resulting effect on reducing drug prices.[1] The model, which is based on country-level modelling, assumes that uptake of recommended health products is influenced by prices, and that increased uptake of more affordable optimal products creates positive economic and health impact.

Accordingly, MPP reports on three main uptake, economic, and health metrics:

• Uptake of MPP-licensed products
  This indicator reports on the amounts of medicines supplied by MPP licensees, both in terms of the number of doses and the corresponding number of people treated (reported as patient-years, where one patient-year corresponds to the quantity of medicines needed to treat one person for one year). For the calculation of total patient-years, the amount of drugs needed for treating one patient for HCV (which is curable, not a lifelong treatment) is counted as one patient-year. This is what MPP licensees have produced and delivered.[2]
• Cost savings
  This indicator reports on the actual financial savings for governments, funders, procurement agencies, and other buyers and implementers brought by accessing MPP-licensed products compared to a scenario where these would not have been licensed by MPP. These are the actual cost savings that MPP licences have enabled.
• Deaths averted
  This indicator reports on the health benefits brought by increased access to WHO-recommended MPP-licensed products compared to a scenario where these would not have been licensed by MPP. These increments in health benefits are those that the people in affected communities have gained from greater use of optimal products over alternative therapeutic options.

^[1]The MPP licences considered for impact calculations are those for: atazanavir (ATV), daclatasvir (DAC), dolutegravir (DTG), ensitrelvir (ENS), lopinavir/ritonavir (LPV/r), molnupiravir (MOL), nirmatrelvir/ritonavir (NIR/r), and tenofovir disoproxil fumarate (TDF).

^[2]For the calculation of total patient-years, the amounts of drugs needed for treating one patient for COVID-19 or HCV (which are curable, not requiring lifelong treatments) are counted as one patient-year.

In addition to these metrics, MPP also reports on other uptake, economic, and health metrics:

• Additional uptake through MPP licences
  This indicator measures the contribution of MPP licences in growing the number of people on licensed products. It looks at the additional uptake of WHO-recommended MPP-licensed medicines compared to a scenario in absence of MPP, considering that at times the same product would have otherwise been procured but at higher prices. This is how much more of these optimal products were used because of MPP licences.
• Theoretical expenditure avoided
  This indicator looks at the investment (or additional expenditure) that would have been needed for the same level of optimal drug uptake in absence of MPP. This is what the global health community would have had to invest to advance health in the same way (i.e. by procuring the same volumes of licensed drugs as is happening).
• Disability-adjusted life years (DALYs) averted (calculated for HIV only)
  This indicator reports on the number of years of healthy life that would have been lost to disability induced by no or suboptimal alternative therapy in absence of MPP. This is the number of healthy years that people in affected communities have gained from greater use of optimal products over alternative therapeutic options.
• Virological failures averted (HIV specific)
  The number of HIV treatment failures that would have taken place in absence of MPP. This is the long-term value of MPP-enabled HIV treatment for people living with HIV on antiretroviral therapy, helping them also benefit from U=U (undetectable = untransmittable).
  

The methodology allows estimation of impact achieved so far (taking advantage of drug supply data obtained from MPP licensees for HIV and HCV products), as well as projections into the future (using the best available treatment uptake forecasts, showcasing the benefits of long-term management of existing MPP licences). Impact achieved so far and projections until 2030 are reported further below.

Exploring the results

Various impact metrics emerging from MPP licences are shown below until 2022, with projections until 2030 for current MPP licences not counting a number of recent licences yet[3], as well as new licences that MPP may get in the coming years.[4]

These impact numbers explore the incremental effects of MPP licences over and above what would have otherwise happened in the absence of MPP. This is the impact of MPP’s work, which is enabled by numerous partners: patent holders, generic manufacturers, procurement agencies, funders, governments, civil society, and communities of people affected by HIV, HCV, COVID-19, and other diseases. This impact is accordingly part of broader global health efforts to roll out optimal treatments in LMICs for which our licensees are key contributors. Together, we recognise and thank all these partners for their contribution in enabling the impact of MPP licences!

^[3]Impact modelling frameworks for new licences such as the recent MPP licence for CAB-LA for PrEP are being considered for development.

^[4]Current MPP priority medicines for in-licensing are presented here: https://medicinespatentpool.org/what-we-do/prioritising-medicines-for-licensing

Access KPMG’s statement on end of 2022 MPP data

Visualising economic and health impact

Costs saved and deaths averted achieved so far are shown below until 2022, with projections until 2030 for current MPP licences. Future licences for emerging products of public health interest will add their contribution to these impact channels.

Reflecting on the benefits from investing in MPP

A benefit-cost ratio for the global health community of financially supporting MPP is calculated by comparing the benefits (i.e costs saved so far and until the end of the current funding cycle in 2025) with the cost of investing in MPP for work in the HIV, HCV, TB, and COVID-19 spaces. This work has been funded by Unitaid since 2010, with the Japanese Government and the Swiss Agency for Development Cooperation (SDC) also funding MPP’s work in relation to COVID-19. The continuous increase seen for the cumulative benefit-cost ratio reflects the importance of long-term effects of MPP licences, brought by enduring licence management until patent expiry. This ratio was 12:1 already in 2015, and 25:1 by the end of 2022; it should grow to at least 33:1 by 2025 (based on current licences – not counting the impact of new licences that MPP may get in the coming years, nor counting the impact of the 2022 licence for CAB-LA for PrEP yet).