OBJECTIVES: Economic utility is usually expressed as incremental cost effectiveness ratio (ICER) and a US$50,000 per QALY threshold is predominantly considered as a cut-off point, beyond a therapeutic approach is no longer considered as cost effective. However it seems us not very reasonable to use this threshold value ubiquitary in all countries, because this arbitrary threshold fails to reflect considerable differences in the structure of the health care systems and the economic power of the respective countries. METHODS: We defined the following criteria, which a country specific cost-effectiveness threshold should fulfill: 1) the threshold must reflect a country’s overall economic performance and take into account dynamic factors like economic growth and inflation; 2) it should not be based on a pure human capital approach; 3) it should be a uniform monetary value in international comparable terms; and 4) reflect the fact that health care spending has a return of investment. RESULTS: We defined the gross domestic product per capita as the most suitable indicator for the first two criteria. To ensure comparability we’ve chosen to correct the values with economy-wide Purchasing Power Parity (PPP) rates. The consideration of the return of investment of health care spending is based on a recent analysis, that every dollar spend on overall health care in the United States results in a health gain worth 1.55 to 1.94 US$. This methods lead to cost-effectiveness thresholds with a large variability, ranging from US$3000 per QALY for countries like Cambodia and Bangladesh up to US$71,000 for Honkong. CONCLUSIONS:The use of this new method may reflect better the country specific affordability than the existing thresholds. The approach offers the decision maker the freedom to make allocation decisions individually for a specific health care system on the basis of the more general Bergson-Samuelson welfare function.