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Adaptive Platform Trials: The Clinical Trial of the Future? Net Present Value (NPV) / MBA Resources

Introduction to Net Present Value (NPV) - What is Net Present Value (NPV) ? How it impacts financial decisions regarding project management?

NPV solution for Adaptive Platform Trials: The Clinical Trial of the Future? case study


At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Adaptive Platform Trials: The Clinical Trial of the Future? case study is a Harvard Business School (HBR) case study written by Ariel D. Stern, Sarah Mehta. The Adaptive Platform Trials: The Clinical Trial of the Future? (referred as “Trial Alexander” from here on) case study provides evaluation & decision scenario in field of Technology & Operations. It also touches upon business topics such as - Value proposition, Health, IT, Operations management, Research & development, Strategy.

The net present value (NPV) of an investment proposal is the present value of the proposal’s net cash flows less the proposal’s initial cash outflow. If a project’s NPV is greater than or equal to zero, the project should be accepted.

NPV = Present Value of Future Cash Flows LESS Project’s Initial Investment






Case Description of Adaptive Platform Trials: The Clinical Trial of the Future? Case Study


In July 2017, Dr. Brian M. Alexander, president and CEO of the AGILE Research Foundation, was preparing to launch a new type of clinical trial-an adaptive platform trial-to study potential therapies for glioblastoma (GBM), an aggressive form of brain cancer. Alexander believed that the standard way in which new cancer drugs were tested-the traditional randomized controlled trial (RCT)-was limited in many ways. While statistically rigorous and still considered the "gold standard" in clinical research, traditional RCTs were time-consuming, costly, and limited to testing just one new drug at a time. Adaptive platform trials, by contrast, facilitated simultaneously studying multiple therapies for a given disease and promised a number of efficiency improvements. They also used statistical techniques to allow more patients to access promising therapies. As such, they had the potential to fundamentally change the clinical research process, making clinical trials for new cancer drugs more efficient, more accessible to patients, and more ambitious in scope. For the past three years, Alexander had been working closely with a group of like-minded oncologists, statisticians, and clinical trial strategists to design an adaptive platform trial for GBM in the hopes of identifying effective therapies more quickly. By mid-2017, Alexander and his colleagues had completed a master protocol for the trial. But now the research team faced several design and operational challenges as they prepared for the trial's launch. Most pressing, how should Alexander and his colleagues finance the trial?


Case Authors : Ariel D. Stern, Sarah Mehta

Topic : Technology & Operations

Related Areas : Health, IT, Operations management, Research & development, Strategy




Calculating Net Present Value (NPV) at 6% for Adaptive Platform Trials: The Clinical Trial of the Future? Case Study


Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 6 %
Discounted
Cash Flows
Year 0 (10012314) -10012314 - -
Year 1 3459042 -6553272 3459042 0.9434 3263247
Year 2 3980683 -2572589 7439725 0.89 3542794
Year 3 3964585 1391996 11404310 0.8396 3328742
Year 4 3233591 4625587 14637901 0.7921 2561307
TOTAL 14637901 12696090




The Net Present Value at 6% discount rate is 2683776

In isolation the NPV number doesn't mean much but put in right context then it is one of the best method to evaluate project returns. In this article we will cover -

Different methods of capital budgeting


What is NPV & Formula of NPV,
How it is calculated,
How to use NPV number for project evaluation, and
Scenario Planning given risks and management priorities.




Capital Budgeting Approaches

Methods of Capital Budgeting


There are four types of capital budgeting techniques that are widely used in the corporate world –

1. Internal Rate of Return
2. Profitability Index
3. Payback Period
4. Net Present Value

Apart from the Payback period method which is an additive method, rest of the methods are based on Discounted Cash Flow technique. Even though cash flow can be calculated based on the nature of the project, for the simplicity of the article we are assuming that all the expected cash flows are realized at the end of the year.

Discounted Cash Flow approaches provide a more objective basis for evaluating and selecting investment projects. They take into consideration both –

1. Magnitude of both incoming and outgoing cash flows – Projects can be capital intensive, time intensive, or both. Trial Alexander shareholders have preference for diversified projects investment rather than prospective high income from a single capital intensive project.
2. Timing of the expected cash flows – stockholders of Trial Alexander have higher preference for cash returns over 4-5 years rather than 10-15 years given the nature of the volatility in the industry.






Formula and Steps to Calculate Net Present Value (NPV) of Adaptive Platform Trials: The Clinical Trial of the Future?

NPV = Net Cash In Flowt1 / (1+r)t1 + Net Cash In Flowt2 / (1+r)t2 + … Net Cash In Flowtn / (1+r)tn
Less Net Cash Out Flowt0 / (1+r)t0

Where t = time period, in this case year 1, year 2 and so on.
r = discount rate or return that could be earned using other safe proposition such as fixed deposit or treasury bond rate. Net Cash In Flow – What the firm will get each year.
Net Cash Out Flow – What the firm needs to invest initially in the project.

Step 1 – Understand the nature of the project and calculate cash flow for each year.
Step 2 – Discount those cash flow based on the discount rate.
Step 3 – Add all the discounted cash flow.
Step 4 – Selection of the project

Why Technology & Operations Managers need to know Financial Tools such as Net Present Value (NPV)?

In our daily workplace we often come across people and colleagues who are just focused on their core competency and targets they have to deliver. For example marketing managers at Trial Alexander often design programs whose objective is to drive brand awareness and customer reach. But how that 30 point increase in brand awareness or 10 point increase in customer touch points will result into shareholders’ value is not specified.

To overcome such scenarios managers at Trial Alexander needs to not only know the financial aspect of project management but also needs to have tools to integrate them into part of the project development and monitoring plan.

Calculating Net Present Value (NPV) at 15%

After working through various assumptions we reached a conclusion that risk is far higher than 6%. In a reasonably stable industry with weak competition - 15% discount rate can be a good benchmark.



Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 15 %
Discounted
Cash Flows
Year 0 (10012314) -10012314 - -
Year 1 3459042 -6553272 3459042 0.8696 3007863
Year 2 3980683 -2572589 7439725 0.7561 3009968
Year 3 3964585 1391996 11404310 0.6575 2606779
Year 4 3233591 4625587 14637901 0.5718 1848816
TOTAL 10473426


The Net NPV after 4 years is 461112

(10473426 - 10012314 )








Calculating Net Present Value (NPV) at 20%


If the risk component is high in the industry then we should go for a higher hurdle rate / discount rate of 20%.

Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 20 %
Discounted
Cash Flows
Year 0 (10012314) -10012314 - -
Year 1 3459042 -6553272 3459042 0.8333 2882535
Year 2 3980683 -2572589 7439725 0.6944 2764363
Year 3 3964585 1391996 11404310 0.5787 2294320
Year 4 3233591 4625587 14637901 0.4823 1559409
TOTAL 9500627


The Net NPV after 4 years is -511687

At 20% discount rate the NPV is negative (9500627 - 10012314 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Trial Alexander to discount cash flow at lower discount rates such as 15%.





Acceptance Criteria of a Project based on NPV

Simplest Approach – If the investment project of Trial Alexander has a NPV value higher than Zero then finance managers at Trial Alexander can ACCEPT the project, otherwise they can reject the project. This means that project will deliver higher returns over the period of time than any alternate investment strategy.

In theory if the required rate of return or discount rate is chosen correctly by finance managers at Trial Alexander, then the stock price of the Trial Alexander should change by same amount of the NPV. In real world we know that share price also reflects various other factors that can be related to both macro and micro environment.

In the same vein – accepting the project with zero NPV should result in stagnant share price. Finance managers use discount rates as a measure of risk components in the project execution process.

Sensitivity Analysis

Project selection is often a far more complex decision than just choosing it based on the NPV number. Finance managers at Trial Alexander should conduct a sensitivity analysis to better understand not only the inherent risk of the projects but also how those risks can be either factored in or mitigated during the project execution. Sensitivity analysis helps in –

What will be a multi year spillover effect of various taxation regulations.

What are the key aspects of the projects that need to be monitored, refined, and retuned for continuous delivery of projected cash flows.

What are the uncertainties surrounding the project Initial Cash Outlay (ICO’s). ICO’s often have several different components such as land, machinery, building, and other equipment.

What can impact the cash flow of the project.

Understanding of risks involved in the project.

Some of the assumptions while using the Discounted Cash Flow Methods –

Projects are assumed to be Mutually Exclusive – This is seldom the came in modern day giant organizations where projects are often inter-related and rejecting a project solely based on NPV can result in sunk cost from a related project.

Independent projects have independent cash flows – As explained in the marketing project – though the project may look independent but in reality it is not as the brand awareness project can be closely associated with the spending on sales promotions and product specific advertising.






Negotiation Strategy of Adaptive Platform Trials: The Clinical Trial of the Future?

References & Further Readings

Ariel D. Stern, Sarah Mehta (2018), "Adaptive Platform Trials: The Clinical Trial of the Future? Harvard Business Review Case Study. Published by HBR Publications.


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