An extensive review of published economic evaluations globally found that as of 2016, >230 economic evaluations were produced annually in low and middle income countries (LMIC), a substantial increase from just a decade earlier [1]. Although the review found room for methodological improvement [2], the demand for economic evaluation to inform health policy will ensure that this continues to be a rapidly evolving field. While increases in the volume of economic evaluations in LMIC are encouraging, the quality of these evaluations will be critical. How then, must we define ‘quality’? Is it accuracy, comprehensiveness, adherence with quality checklists? These measures of quality are clearly important in their own right, but they are proxies for the reason we conduct economic evaluation in the first place: to make the ‘right’ allocation and/or investment decisions. Such decisions are commonly about what should or should not (or, can or cannot) be funded, reimbursed or procured in our health systems by governments, insurers and provider networks, and donors and development partners. If the quality of an economic evaluation is a function of the decision it intends to inform, we need to acknowledge the dynamics of health policy decisions where economic evaluations are being used: whether these decisions are prospective or retrospective, are routine institutional or one-off decisions, and whether the interventions assessed are individual technologies such as medicines or are complex multi-interventional programmes (or somewhere in-between).