OBJECTIVES: Although cost-effectiveness (CE) thresholds have been applied in health technology assessment (HTA) for decades, in Brazil decisions have been made since 2011 without defining this parameter. Typically, a threshold of 3 times the gross domestic product (GDP) per capita was applied, following references from World Health Organization. However, in 2022 the Ministry of Health published a 1 GDP per capita recommendation. In this work we present evidence-based questions on how this threshold is low to allow health innovation in Brazil's public health system (SUS).

METHODS: A systematic search was conducted in open databases (Google Scholar and Pubmed) on CE thresholds in countries with dedicated HTA processes. In addition to this search, information was sought in agencies' own public domains. Once located, the general thresholds were extracted in dollars and GDP per capita. In addition, the countries' GDP per capita was validated on the World Bank website.

RESULTS: CE thresholds found were: United States (U$50,000), United Kingdom (U$25,000 to U$37,700), Canada (U$50,000), Chile (U$23,300), Colombia (U$6,000), Mexico (U$11,000) and Brazil (U$8,000). These values represent in GDP per capita (2022): United States: 0.65; United Kingdom: 0.82; Canada: 0.90; Chile: 1; Colombia: 1; Mexico: 1; and Brazil: 1.

CONCLUSIONS: Brazil, as a developing country, has an automatic prejudice on CE threshold values as the Brazilian GDP per capita is approximately 8.5 times lower than US and 5 times lower than UK. Additionally, the threshold proposed for Brazil is 6.7 times lower than the American one and 5 times lower than the British one. Furthermore, Brazilian GDP per capita is lower than the Latin American average (U$9,747). It is known that CE threshold is just one of the factors considered in the HTA´s final recommendation. However, we believe that this reduction from 3 to 1 GDP per capita will be a barrier to innovative technologies in SUS.