Objectives: The objective of this study was to evaluate the methodological characteristics of cost-effectiveness evaluations carried out in Spain since 1990 which include LYG as an outcome to measure the incremental cost-effectiveness ratio. Methods: A systematic review of published studies was conducted describing their characteristics and methodological quality. We analyze the cost per LYG results in relation with a commonly-accepted Spanish cost effectiveness threshold and the possible relation with the cost per quality adjusted life year (QALY) gained when they were both calculated for the same economic evaluation. Results: A total of 62 economic evaluations fulfilled the selection criteria, 24 of them including the cost per QALY gained result as well. The methodological quality of the studies was good (55%) or very good (26%). A total of 124 cost per LYG results were obtained with a mean ratio of 49,529€ and a median of 11,490€ (standard deviation of 183,080). Since 2003, a commonly-accepted Spanish threshold has been referenced by 66% of studies. A significant correlation was found between the cost per LYG and cost per QALY gained results (0.89 Spearman-Rho, 0.91 Pearson). Conclusions: There is an increasing interest for economic healthcare evaluations in Spain and the quality of the studies is also improving. Although a commonly-accepted threshold exists, further information is needed for decision making as well as to identify the relationship between the costs per LYG and per QALY gained.Response to Reviewers: We decided to give response to specific reviewer and editor comments in this box and uploading the corresponding attachment file as well.

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