OBJECTIVES: Cancer patients from lower income countries such as India often have limited access to modern medicines because of high costs.  Using multiples of India’s per capita GDP as the threshold for economic value as suggested by the World Health Organization (WHO), decision analysis modeling was used to estimate a monthly cost for a hypothetical new cancer drug that provides a 3 month survival benefit to patients with metastatic colorectal cancer (mCRC). METHODS: A decision model was developed to simulate progression free and overall survival in mCRC patients receiving chemotherapy ± the new drug.  Outcomes for cancer control and side effects were obtained from randomized trials evaluating 1st and 2nd line chemotherapy in mCRC.  Costs for chemotherapy were obtained from both public and private hospitals in India.  Utility estimates measured as quality-adjusted life years (QALY) were determined from 24 oncology nurses using the Time Trade-Off technique.  These data were then used to estimate the monthly cost of the new drug using a threshold of $9,300 per QALY gained, which is three times the Indian per capita GDP, as recommended by the WHO. RESULTS: The base case analysis suggested that a monthly cost of $U.S.98 would be considered cost effective from the Indian public health care perspective.  If the drug were able to improve patient quality of life above the standard of care or survival from 3 to 6 months, the monthly drug cost could increase to $U.S.170 and $U.S.253 and offer the same value. CONCLUSIONS: The use of the WHO criteria for estimating a country-specific drug price based on economic value for a developing country is feasible.  However, the challenge would be to identify an appropriate threshold that would provide a balance between what patients/governments can afford to pay and the commercial viability of the product in the reference country.