OBJECTIVES: To appraise economic evaluations of health technologies that included QALYs as an outcome measure conducted over the last seven years in Spain. METHODS: Economic evaluations that included QALYs as an outcome measure, conducted in Spain and published between January, 2003 and April, 2009 were identified. A combination of terms was applied to systematically review electronic and grey literature sources. Three Spanish journals were hand searched. Methodological quality was assessed applying the National Institute of Clinical Excellence (NICE) 10 criteria checklist and the Oxford Centre for Evidence Based Medicine (CEBM) recommendations for appraising economic evaluations. RESULTS: After applying the inclusion and exclusion criteria, a total of 48 papers and 1 Health Technologies Evaluation Agency (HTEAs) report were included. Key findings: 1) 69.5% of papers referred to therapeutic interventions; 30.4% to preventive strategies; 2) no assessments of diagnostic procedures were identified; 3)10.4% dealt with medical devices; 4) Markov modelling was frequently applied (58.7%); 5) the NHS perspective was commonly adopted (56.5%); 6) costs and effects were usually discounted (71.7%); 7) probabilistic methods were reported in 36.4% papers; 8) in 91.9%, either the ICER or ICUR was stated; 9) effectiveness, costs and utility data came from Spanish sources in 15.2% publications; 10) 60.8% of studies were of 3b level of evidence mainly due to the diverse nature of the sources consulted to gather data, estimate utilities and design models;11) 89% of authors compared their findings against an accepted threshold of €30,000 per QALY, but little attention was given to contrasting results or addressing other implementation issues; 12) 45.6% reported the source of funds. CONCLUSIONS: A small number of economic evaluations using QALYs was conducted. Diagnostic and preventive interventions as well as medical devices were scarcely considered. Low evidence scores show that important methodological limitations remain unsolved to produce reliable estimates to guide the allocation of resources.