If your team is preparing a pharmacoeconomic dossier for Brazil, Colombia, Mexico, Peru or any other Latin American country in 2026, the first question every payer or HTA reviewer will eventually ask is the same: what is your ICER, and against which threshold should it be compared?

The honest answer for most of the region is uncomfortable: it depends. Some countries have explicit thresholds. Others have informal benchmarks. A few rely on the long-discredited "1 to 3 times GDP per capita" rule from the World Health Organization (WHO), a benchmark the WHO itself has formally walked back. This article maps the current state across Latin America, with the verified figures you need to defend your submission.

1. The global context: the WHO threshold is no longer the standard

The "1 to 3 times GDP per capita per QALY" rule that dominated cost-effectiveness analysis for two decades is no longer endorsed by the WHO itself. The organization has publicly stated that this practice is a distortion of the original WHO-CHOICE intent and should not be used at the country level for funding decisions or price-setting.

The most rigorous global estimate to date, published by Pichon-Riviere et al. in The Lancet Global Health (2023), modeled cost-effectiveness thresholds for 174 countries based on health expenditure per capita and life expectancy. The finding: in 97% of countries the threshold per QALY sits below 1 GDP per capita, not 1 to 3. For lower-middle-income countries it falls below 0.5 GDP per capita in 76% of cases.

The implication for Latin America is direct. Defending a submission with the assumption that any ICER below 3 GDP per capita is acceptable is no longer defensible methodologically. Modern reviewers know this. Your dossier should know it too.

2. Brazil: the first explicit threshold in Latin America

Brazil moved first. CONITEC, the national HTA agency, established in 2022 an explicit cost-effectiveness reference value of BRL 40,000 per QALY (approximately USD 8,200 at 2022 exchange rates), aligned with roughly 1 GDP per capita.

The framework has important nuances:

The threshold is a reference value, not a knockout criterion. CONITEC has explicitly stated that cost-effectiveness should not be used in isolation from other factors.
For specific contexts (rare diseases, severe diseases with significant quality-adjusted survival reductions, pediatric conditions, endemic diseases in low-income populations), a threshold of up to 3 times the reference value (BRL 120,000) is acceptable.
For rare diseases specifically, the explicit threshold was set at approximately USD 24,233 per QALY in 2022.
CONITEC historically prefers cost-effectiveness analyses based on incremental cost per life year or per avoided event over incremental cost per QALY, although QALY is now the guiding measure.
Budget impact is often weighted as heavily as, or more than, cost-effectiveness given fiscal constraints in the SUS (Brazilian public health system).

Practical implication: a submission to CONITEC needs a defensible QALY-based ICER against the BRL 40,000 reference, plus a strong BIA, plus a contextual argument if the ICER exceeds the threshold.

3. Colombia: a threshold proposed by IETS but not yet formally regulated

Colombia is a unique case. The Colombian HTA agency (IETS, Instituto de Evaluación Tecnológica en Salud), with funding from the Ministry of Finance, commissioned and published an empirical estimate of the country's cost-effectiveness threshold.

The estimate (Espinosa et al., published in Health Policy and Planning, 2022) places the threshold at approximately USD 4,488 per year of life lost avoided and USD 5,181 per QALY gained (at 2019 prices), close to 1 GDP per capita. IETS has incorporated this figure into the second version of its health economic evaluation manual.

However, the threshold has not been formally regulated by Colombia's Ministry of Health and Social Protection. This means submissions to IETS face a methodologically defined benchmark, but reimbursement decisions are not bound to it. The practical effect: market access teams in Colombia need to defend their ICER against the IETS reference value while recognizing that final decisions integrate budget impact, equity considerations and political context.

4. Peru: the only Latin American country with a threshold not based on GDP

Peru's National Institute of Health (INS) established in 2020 a cost-effectiveness threshold range of between 1 and 2 UIT (Unidad Impositiva Tributaria) per year of healthy life gained, approximately USD 2,500 to USD 5,100 at 2021 exchange rates.

What makes Peru distinct is the choice of reference unit. By tying the threshold to UIT, an independent fiscal indicator updated annually, rather than to GDP per capita, Peru aligned with the growing literature criticizing GDP-based thresholds as insufficiently responsive to the real opportunity cost of public health investment in resource-constrained settings.

A study by Kazibwe et al. analyzed 197 health economic evaluations across Latin America and found that all of them used CE thresholds based on GDP per capita. Peru's INS move is the only formal departure from that pattern in the region to date.

5. The rest of Latin America: GDP-based thresholds and informal practice

Outside Brazil, Colombia and Peru, no Latin American country has a formally established cost-effectiveness threshold. Mexico, Argentina, Chile, Ecuador and others rely on implicit GDP-based benchmarks in practice.

Comparative analysis presented at ISPOR (2024) summarized practical thresholds in use:

Chile: ~USD 23,300 per QALY (approximately 1 GDP per capita)
Mexico: ~USD 11,000 per QALY (approximately 1 GDP per capita)
Colombia: ~USD 6,000 per QALY (approximately 1 GDP per capita)
Brazil: ~USD 8,000 per QALY (approximately 1 GDP per capita)

These are working figures used by industry and reviewers, not regulated benchmarks. Submissions in these countries should be prepared to defend the ICER against the implicit local threshold and against international references (NICE, CADTH).

6. What this means for your next submission

For market access teams operating across Latin America in 2026, three operational principles apply:

Build country-specific dossiers, not regional ones. A single ICER value defended against "Latin America" is not a defensible dossier. Each country has its own threshold, formal or informal, and its own reviewer expectations.
Stop defaulting to 3x GDP per capita. The WHO no longer endorses this benchmark. Modern reviewers will challenge it. Use the explicit threshold where it exists (Brazil, Colombia via IETS, Peru) and the lower end of the empirical range (0.5 to 1 GDP per capita per QALY) where it does not.
Pair every ICER with a strong budget impact analysis. In countries with fiscal pressure (which is most of Latin America), BIA is often the deciding factor regardless of how good the ICER looks.

How Quantus helps

Quantus builds country-adapted cost-effectiveness and budget impact models for Latin American submissions, with thresholds calibrated to each country's actual regulatory and payer expectations, not generic regional assumptions. Six weeks, not six months, with the value story ready to defend in front of the payer.

If you have a product preparing for regional access in 2026, write to us.

References

[1] World Health Organization. Statement on cost-effectiveness thresholds and the misuse of the 1-3 GDP per capita recommendation. Available at: who.int

[2] Pichon-Riviere A, Drummond M, Palacios A, et al. Determining the efficiency path to universal health coverage: cost-effectiveness thresholds for 174 countries based on growth in life expectancy and health expenditures. Lancet Global Health. 2023;11(6):e833-e842.

[3] Grubert N. Will Brazil soon have an explicit cost-effectiveness threshold? CONITEC public consultation summary. Available at: linkedin.com/in/neilgrubert

[4] Oliveira E, Xavier L, Louly P, et al. Impact of the cost-effectiveness threshold on drug funding recommendations: the case of rare diseases in Brazil. International Journal of Technology Assessment in Health Care. 2025. doi:10.1017/S0266462324002356

[5] Espinosa O, Rodríguez-Lesmes P, Orozco L, et al. Estimating cost-effectiveness thresholds under a managed healthcare system: experiences from Colombia. Health Policy and Planning. 2022;37(3):359-368. doi:10.1093/heapol/czab146

[6] Aravena P, et al. Use of Cost-Effectiveness Thresholds in Healthcare Public Policy: Progress and Challenges. Applied Health Economics and Health Policy. 2024. doi:10.1007/s40258-024-00900-5

[7] Cubillos L. An incomplete step in the right direction: Peru's National Institute of Health establishes cost-effectiveness threshold. PMC. 2022. Available at: ncbi.nlm.nih.gov/pmc

[8] ISPOR. Cost-Effectiveness Thresholds Around the World: How Brazil Positions Itself Compared to Other Countries. ISPOR Presentations Database. 2024. Available at: ispor.org