Candidate instructions:

Mrs Collette is a 38-year-old woman with metastatic renal cancer. Her disease has progressed despite two courses of chemotherapy over the past six months. She wants to discuss the use of Avastin. This drug has been shown to improve disease-free survival by 5-6 months but costs up to £90,000 per `QALY' and has therefore not been approved by NICE. Explain to Mrs Collette that the drug is not available on the NHS.

https://dai.ly/k1SJEBzunkjJTyzyb1r

https://dai.ly/k5QGO1zQ2dtZR4zyb1t

Examiner instruction:

A good candidate:

• will explain the rationing role of NICE while acknowledging this affords little reassurance or comfort to individuals
• will steer the conversation away from the details of the NICE decision towards other strategies for obtaining further treatment
• will explain that PCT trusts can consider funding treatment on a case-by-case basis
• will explain that medical trials are another means by which patients may gain access to treatment.

Keyword/ Phrases:

This is essentially breaking bad news. You are telling a patient that a drug that may be effective for them is not going to be prescribed. What you are being tested on here is your knowledge of Avastin, management of renal cell carcinoma, or of in-depth knowledge of QALYs or ICERs which are used by NICE to determine whether or not a drug can be prescribed on the NHS.