Interviewer view · keep this screen to yourself

Launching a new drug in England

You run the case. Read the prompt, answer questions from the notes below, and share data only when the candidate asks for it or gets stuck. Score at the end.

Case timer

00:00

Target length:

1. Read the prompt aloud

Read it slowly, then pause. Let the candidate ask questions before they structure.

A drug maker plans to launch a new drug in England at GBP 28,000 per course. Trials show it adds 0.5 QALYs per patient compared with the current treatment. About 8,000 patients a year are eligible, and about half would get it once approved. The exhibit summarizes the costs. Will it be approved at this price, and what should the company do?

Format note: Interviewer-led: the interviewer shows the cost table and asks for the cost per QALY.

2. Answers to clarifying questions

Give these answers only if the candidate asks. If they ask something not listed, give a sensible answer or say it does not matter here.

If asked: Which treatment does the new drug replace?
Answer: The current standard treatment, costing GBP 5,000 per course.
If asked: What threshold should I use?
Answer: Assume GBP 35,000 per QALY, the upper end of the current range.
If asked: Does the drug save other costs?
Answer: Yes, fewer hospital days, worth about GBP 3,000 per patient.

3. The hypothesis a strong candidate states

Listen for an early, testable guess like this one. It does not need to match word for word.

The proposed price is 5.6 times the current treatment. My hypothesis is that the cost per QALY is above the threshold at that price and that a modest discount is needed to get approval.

4. A model structure

Compare the candidate's structure with this one. A different split can be just as good if it is clean and fits the problem.

Cost per QALY versus the thresholdThis comes from cost per QALY = extra cost after offsets / extra QALYs, compared with the threshold, which sets the highest price.
- Extra cost after offsets
- Key: Cost per QALY
- Maximum price at the threshold
- Revenue at that price

Exhibit 1

Reveal to candidate: when they ask for this data, say "Open Exhibit 1" (they press "Show exhibit 1" on their screen).

New drug versus current treatment, per patient (illustrative)

New drug versus current treatment, per patient (illustrative)
Item	Current treatment	New drug
Price per course (GBP)	5,000	28,000
Hospital costs avoided (GBP)	0	3,000
QALYs gained versus current treatment	0	0.5

So-what

The new drug gives real benefit and saves some hospital cost, but at GBP 28,000 its cost per QALY is above the current threshold range.

5. The working, step by step

Each step shows how a strong candidate works it out. Share a new fact from it only when the candidate asks or is stuck, and let them do the math: the result in the dark box is what they should reach.

Step 1: Extra cost per patient
What a strong candidate does: New drug price minus current treatment minus hospital costs avoided.
Extra cost (GBP): 28,000 - 5,000 - 3,000 = 20,000
Step 2: Cost per QALY
What a strong candidate does: Extra cost divided by 0.5 extra QALYs: above the GBP 35,000 upper threshold.
Cost per QALY (GBP): (28,000 - 5,000 - 3,000) ÷ 0.5 = 40,000
Step 3: Maximum price at the threshold
What a strong candidate does: Threshold times QALYs gained, plus the costs the drug replaces or avoids.
Maximum price (GBP): 35,000 × 0.5 + 5,000 + 3,000 = 25,500
Step 4: Discount needed
What a strong candidate does: From GBP 28,000 to GBP 25,500.
Discount (%): (28,000 - 25,500) ÷ 28,000 × 100 = 8.93
Step 5: Patients treated
What a strong candidate does: Half of 8,000 eligible patients.
Patients a year: 8,000 × 0.5 = 4,000
Step 6: Revenue at the maximum price
What a strong candidate does: 4,000 patients at GBP 25,500.
Revenue (GBP a year): 4,000 × 25,500 = 102,000,000

The recommendation to listen for

At the end, say: "The CEO walks in. What is your recommendation?"

At GBP 28,000 the drug is unlikely to be approved, but a discount of about 9 percent, to about GBP 25,500, brings it within the GBP 35,000-per-QALY upper threshold. First, the cost per QALY at the list price is about GBP 40,000, above the current GBP 25,000 to 35,000 range. Second, at GBP 25,500 it sits at the upper threshold and could reach about 4,000 patients a year, about GBP 102 million of revenue, against nothing if rejected. Third, the hospital days it saves are a strong part of the value story and should be evidenced well. Offer the discount through a confidential agreement if the company wants to protect its list price in other countries.

Risks a strong answer names: The assessment may judge the QALY gain or hospital savings as lower than the trials suggest; A lower price in England may be used as a reference by other countries.

Next steps: Strengthen evidence on hospital days avoided; Prepare a pricing agreement with a discount of about 9 percent.

Strong versus weak

A strong answer

Included cost offsets, calculated cost per QALY, found the maximum price at the threshold, and compared approval at a discount with rejection.

A weak answer

Argued the price was fair because the drug is innovative, without calculating cost per QALY.

Score the candidate

Score each criterion from 1 to 5. A 2 or a 4 sits between the descriptions.

Structuring

1: No clear structure, or a memorized framework that does not fit the problem.
3: A sensible structure, but with some overlap, a gap, or no clear priority.
5: A structure built for this problem, with no overlap and no gaps, a stated hypothesis, and a clear first step.

Math

1: Frequent errors, no units, or needed heavy help to finish.
3: Right answers but slow or messy working, or one error caught late.
5: Accurate and clearly narrated, with units, a sense check, and what the number means.

Exhibit reading

1: Read the chart aloud without finding the number that matters.
3: Found the key number but gave only part of the so-what.
5: Pulled the right number quickly and said what it means for the case.

Synthesis

1: Summarized what was done, with no clear answer.
3: Gave an answer, but with weak reasons or no next step.
5: Answer first, then two or three reasons with numbers, the main risk, and next steps.

Communication

1: Hard to follow: long silences, no signposting.
3: Clear most of the time, with some rambling.
5: Calm and concise, signposted each step, and checked in with the interviewer.

Total

0 out of 25

Score all five criteria to see the band and the feedback template.