A QALY is an area

Quality of life on the vertical axis, years on the horizontal. Drag either corner. The area under each profile is its QALYs.

Drag the corner handles  ·  or focus one and use ←→↑↓

—
incremental QALYs gained: the area between the two profiles
Intervention—
utility × years—
Comparator—
utility × years—

A utility of 1.0 is full health and 0 is equivalent to being dead. Values below zero are possible and mean a state judged worse than death, which is why the axis runs a little below the line. Utilities come from the general public, not from patients, and India has its own EQ-5D-5L value set: applying UK tariffs to Indian patients is a flaw a reviewer should catch.

Notice how differently the same gain can be produced: more years at the same quality, the same years at better quality, or fewer years at much better quality. All three are the same number of QALYs, and the QALY cannot tell them apart. That is the measure's central limitation, not a bug in this widget.