The quality-adjusted life year (QALY) is a widely used measure in economic evaluation to summarize health outcomes, incorporating both the quantity and quality of life. It is used to assess the impact of healthcare interventions on health outcomes and to inform resource allocation decisions. The QALY combines the effects of health interventions on mortality and morbidity into a single index, enabling comparisons across different disease areas. It is calculated by multiplying the duration of time spent in a health state by the health-related quality of life (HRQoL) weight associated with that state. The QALY approach has been widely adopted, particularly by the National Institute for Health and Clinical Excellence (NICE) in the UK, for health technology assessment. However, the QALY approach has faced criticism for its limitations, including its inability to capture all aspects of health benefits, its blindness to equity concerns, and its underlying theoretical assumptions. There is ongoing debate about whether QALYs should be discounted to current values and whether they should be weighted differently based on equity considerations. Additionally, there is debate about who should value health states, with some arguing that patients should value their own health states, while others argue that the general population should be used for valuation. Alternative measures, such as the disability-adjusted life year (DALY), healthy years equivalent (HYE), and willingness-to-pay (WTP) approach, have been proposed as alternatives to the QALY. The DALY measures the impact of illnesses and injuries on the loss of healthy life years, while the HYE is a measure of quality of life based on a two-stage procedure. The WTP approach uses monetary values to assess the value of health benefits. The QALY approach is considered the cornerstone of economic analysis, but it has been the subject of debate due to its underlying assumptions and methodological issues. While some argue for alternatives to the QALY, the general emphasis is on improving the current QALY approach by addressing the challenges posed by it. Further research is needed to enhance the QALY approach to deal with challenges relating to equity-weighted utility maximization and testing the validity of underlying assumptions.The quality-adjusted life year (QALY) is a widely used measure in economic evaluation to summarize health outcomes, incorporating both the quantity and quality of life. It is used to assess the impact of healthcare interventions on health outcomes and to inform resource allocation decisions. The QALY combines the effects of health interventions on mortality and morbidity into a single index, enabling comparisons across different disease areas. It is calculated by multiplying the duration of time spent in a health state by the health-related quality of life (HRQoL) weight associated with that state. The QALY approach has been widely adopted, particularly by the National Institute for Health and Clinical Excellence (NICE) in the UK, for health technology assessment. However, the QALY approach has faced criticism for its limitations, including its inability to capture all aspects of health benefits, its blindness to equity concerns, and its underlying theoretical assumptions. There is ongoing debate about whether QALYs should be discounted to current values and whether they should be weighted differently based on equity considerations. Additionally, there is debate about who should value health states, with some arguing that patients should value their own health states, while others argue that the general population should be used for valuation. Alternative measures, such as the disability-adjusted life year (DALY), healthy years equivalent (HYE), and willingness-to-pay (WTP) approach, have been proposed as alternatives to the QALY. The DALY measures the impact of illnesses and injuries on the loss of healthy life years, while the HYE is a measure of quality of life based on a two-stage procedure. The WTP approach uses monetary values to assess the value of health benefits. The QALY approach is considered the cornerstone of economic analysis, but it has been the subject of debate due to its underlying assumptions and methodological issues. While some argue for alternatives to the QALY, the general emphasis is on improving the current QALY approach by addressing the challenges posed by it. Further research is needed to enhance the QALY approach to deal with challenges relating to equity-weighted utility maximization and testing the validity of underlying assumptions.