Who has the most influence on HTA and reimbursement decisions in the UK? A pilot study of drugs Alzheimer's disease

Summary Objectives: To identify and analyze the most influential individuals involved in the health technology assessment (HTA) and reimbursement of drugs for Alzheimer’s disease in the UK together with individuals’ interconnections within a complex HTA network. Methods: Three national UK HTA agencies (NICE, SMC, AWMSG) were identified as the most important for reimbursement decisions in the UK. Information about agencies’ members was extracted from the agency websites, then supplemented by additional data and divided into different categories (person’s role, specialization, membership of other organizations, etc.). Next, HTA reports published from 2001-2012 were identified which described the HTA of one or more treatments of Alzheimer’s disease. Information about the individuals involved in those assessments was extracted from the reports and put in the database. A scoring algorithm was developed to calculate each person’s weight of influence based on involvement in assessments and membership to the HTA agencies and other organizations. A visualization tool was applied to the dataset to observe interconnections. Results: In total, 291 individuals were directly or indirectly involved in the HTA process. The majority of them (61%) were clinicians, whereas 11% and 16% had an economic and policy background respectively. We identified a segment of top influential people within the dataset and analyzed their interconnections (involvement in multiple assessments, organizational affiliations).The NHS, University of Southampton, University of Glasgow, and NIHR HTA were identified as key organizations indirectly involved in HTA through their members’ connections. Discussion: This pilot study provides some insight into the UK HTA and reimbursement process at the people level within the therapeutic area of Alzheimer’s disease and shows that clinicians have the most influence on HTA and reimbursement in the UK. The results can be used for development of the pharmaceutical market access strategy. The research has methodological limitations and further methodology validation will be conducted in future studies.