OBJECTIVES: Many countries have a national Health Technology Assessment (HTA) body that makes decisions/recommendations on publically reimbursing new healthcare technologies. For some, a key criterion is cost-effectiveness based upon their cost per Quality Adjusted Life Year (QALY) in relation to willingness to pay (WTP) thresholds. This research aims to identify, compare and evaluate WTP thresholds across countries.

METHODS: Publically-available HTA guidelines were screened for 35 countries across Europe, Asia-Pacific, and the Americas for key criteria for decision-making and WTP thresholds.

RESULTS: CONCLUSIONS: The WTP for a QALY can vary substantially between as well as within countries. The WHO recommends a WTP of <3 times GDP per capita/QALY, which few countries follow. If other markets adopted this WHO standard it would substantially increase their WTP thresholds. From a utilitarian perspective, WTP should be consistent across diseases. Another perspective is that WTP should reflect the opportunity cost; new interventions with higher budget impacts should have lower WTP thresholds, supporting higher WTP for orphan diseases.