BACKGROUND We present a systematic review describing ex-ante and ex-post evaluations of the impacts of intellectual property provisions in trade treaties on access to medicine in low and middle income countries. These evaluations focused on multilateral and bilateral trade agreements. We ascertained which IP provisions impacting access to medicines were the focus of these evaluations. We provide a further research agenda related to investigating the effect of trade agreement's intellectual property provisions on access to medicines. We followed systematic review guidelines with 7 different databases to identify post-2000 ex ante and ex post evaluations of trade treaties on access to medicines in low and middle-income countries. We included only quantitative ex-ante studies that used structural modeling and simulations to derive quantitative predictions and ex-post studies that utilized empirical data and econometric techniques to quantify the effects of intellectual property provisions in free trade agreements on host country's pharmaceutical industry. The search strategy identified 744 titles after removal of duplicates. We identified 14 studies that fulfilled all eligibility; 7 studies are ex-ante and 7 are ex-post. The studies looked at medicine price and cost, affordability, welfare effects and speed of medicine market launch. Changes in intellectual property policy due to the implementation of trade agreements affect price, medicines expenditure and sales, consumer welfare, and ultimately the affordability, of medicines. The direction and magnitude of the price effects differ between ex-ante and ex-post studies. Further, the reported impacts of policy changes due to trade agreements on medicine access seem clearly multifactorial. CONCLUSION Both ex ante and ex post methods have advantages and limitations and, on balance, both types report, for the most part, an increase in price and a decrease in consumer welfare with imposition of intellectual property protection in trade agreements. The main differences between these studies are in the magnitude of the changes. There is a gap in our empirical understanding of the mechanisms through which such changes affect access to medicines and which outcomes relevant to access are most affected by which type of changes in intellectual property policy and law.

中文翻译：

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贸易条约中知识产权条款对低收入和中等收入国家获得药品的影响：系统评价。

背景 我们提出了一项系统综述，描述了贸易条约中知识产权条款对低收入和中等收入国家获得药品的影响的事前和事后评估。这些评估侧重于多边和双边贸易协定。我们确定了哪些影响药品获取的知识产权条款是这些评估的重点。我们提供了与调查贸易协定知识产权条款对药品获取的影响相关的进一步研究议程。我们遵循 7 个不同数据库的系统审查指南，以确定 2000 年后对低收入和中等收入国家药品获取贸易条约的事前和事后评估。我们仅纳入了使用结构建模和模拟得出定量预测的定量事前研究，以及利用实证数据和计量经济学技术来量化自由贸易协定中知识产权条款对东道国制药业影响的事后研究。删除重复项后，搜索策略识别出 744 个标题。我们确定了 14 项符合所有资格的研究；7 项研究是事前研究，7 项研究是事后研究。这些研究着眼于药品价格和成本、负担能力、福利影响以及药品市场启动的速度。贸易协定的实施导致知识产权政策的变化影响价格、药品支出和销售、消费者福利，并最终影响药品的承受能力。事前研究和事后研究之间价格影响的方向和幅度有所不同。此外，据报道，贸易协定对药品获取造成的政策变化的影响显然是多因素的。结论 事前和事后方法都有优点和局限性，总的来说，这两种类型的报告在很大程度上都会因在贸易协定中实施知识产权保护而导致价格上涨和消费者福利下降。这些研究之间的主要区别在于变化的幅度。我们对这些变化影响药品获取的机制以及与获取相关的结果受知识产权政策和法律的哪类变化影响最大的机制的实证理解存在差距。