OBJECTIVES: Quality-Adjusted Life Years (QALYs) are widely used in cost-effectiveness analysis and have been calculated for different population groups and disease states; however, the literature falls short in providing country-specific QALYs or as it is commonly referred quality-adjusted life expectancy (QALE).  The aim of this paper is: 1) to develop county-level QALE; 2) to calculate country-specific average cost-effectiveness ratios (ACERs); 3) to rank countries based on QALE and ACERs, and 4) to analyze how economic, social and environmental factors affect country-specific QALE. METHODS: The Medical Expenditure Panel Survey data was used to estimate the relationship between EQ-5D-3L health utility index, age and some prevalent disease states after controlling for socio-demographic characteristics. Next, these estimates were combined with data on country-specific average life expectancy, disease prevalence (Global burden of disease study) and medical expenditures (World Health Organization) to derive country-specific health utility scores, QALE and ACERs. Finally, using country level regression analysis, we analyze how country-specific social, economic and environmental factors affect the QALE. RESULTS: : There were 83 countries in the sample. Countries were ranked based on life expectancy, healthcare expenditures, QALE and ACERs. Adjusted analysis of all countries revealed that those with higher per-capita healthcare expenditures generally had higher QALE. Better sanitation level and larger forest area were associated with greater QALE. In addition, higher CO2 emissions and greater inequality, measured by GINI index, were associated with lower QALE. These factors explained 81% of variations in QLAE.  The US had the highest healthcare expenditures per capita; however it ranked 33^rd in QALE. As a result, the US had the worst (highest) ACER.  CONCLUSIONS: Healthcare expenditures have a positive impact on QALE, but are not the only significant factor. Sanitation, forest area, CO2 emissions and income distribution also have a significant effect on it.