A review.Despite the obvious benefits of a QbD-driven drug development approach, implementation of the new paradigm has so far been slow and rudimentary in the pharmaceutical industry.Potential annual savings of 20-30 billion $ were predicted by McKinsey in 2009.The author's own survey in autumn 2011 revealed, that among the companies that had adopted QbD in Europe, only 52% felt that they had gained from the approach.Even they could, however, not measure the actual return on investment (ROI) and 13% of the adopters believed that their expectations were not going to be fulfilled at all.This is directly associated with the substantial costs and complexity of applying QbD to traditional, multi-step manufacturing technologies.In August 2011, the US FDA's "Advancing Regulatory Science at FDA - a Strategic Plan" started promoting Quality by Design and highlighted continuous processing technologies (e.g. hot melt extrusion), the use of process anal. technol. and the development of new statistical approaches.Hot melt extrusion has now finally made its way into the manufacturing technologies for oral drug products after extensive use over the last decades in other industries.Establishing hot melt extrusion as a continuous manufacturing technol. for oral drug products certainly still faces substantial challenges, but when 'married' to QbD, this technol. will provide new opportunities for the development and manufacturing of modern dosage forms via a fully understood process, enabling improved manufacturing efficiency, and continuous, real time assessment of the process and product quality.The coupling of hME and QbD will improve the quality of drug products and thus patients' safety by a process amendable to continuous improvement throughout product lifecycle.