Health technology assessments based on incremental cost-effectiveness ratios (ICERs) have been used to define decision rules and inform reimbursement decisions for decades. Costs typically include the projected cost of the interventions and disease management. Benefits are frequently measured using relevant outcomes, such as quality-adjusted life years (QALYs) or disability adjusted life years (DALYs), that combine improvements in life expectancy and quality-of life or-reductions in disability. Nevertheless, some developing countries have adopted or are considering adopting decision rules that measure health benefits as improvements in life years (LY) only instead of combined measures. The aim of our study is to discuss the differences between these measures and assess the likely impact for healthcare decision-making. A simulation study was performed to compare the impact of LYs, QALYs, and DALYs on ICERs. We considered scenarios when the true standardized effect measures for all outcomes were the same (zero difference) in addition to evaluating a range of decrements in the QALYs gained and DALYs avoided (0.05-0.90) from multiple distributions over varying lengths of incremental LY. There was substantial variability in the ICERs obtained from the 3 methods for many of the scenarios. Although LYs saved is a transparent and intuitive measure to compare the benefits of interventions, it does not consider the impact of disease severity. As a result, the ICER based on LY does not quantify the value of health improvements such as improved physical ability or reduced pain when comparing interventions. Defining ICER decision rules based solely on LY and not considering QALYs nor DALYs may lead to the reimbursement rejection of interventions that have a small impact on LY, but a large impact on the effect value to patients.