Background: Mongolia bears one of the highest global burdens of viral hepatitis and hepatocellular carcinoma (HCC), with late-stage diagnosis remaining common. Economic evaluation is essential for prioritizing interventions in this high-burden, resource-constrained setting; however, locally derived health-state utility values for liver diseases are currently unavailable.

Objective: To derive culturally and contextually relevant utility values for major liver disease health states in Mongolia to support cost-effectiveness analyses and evidence-informed cancer control policy.

Methods: We conducted a cross-sectional, interviewer-administered valuation study between August and October 2025 in urban and rural regions of Mongolia, including Ulaanbaatar and multiple rural provinces. Quota-based sampling was used to approximate national distributions of age, sex, education, and urban–rural residence. A precision-based sample size of 139 adults was selected to ensure stable mean utility estimates. Participants evaluated eight predefined liver disease health states that were culturally adapted and refined through expert review. Health states included chronic hepatitis B, chronic hepatitis C, metabolic dysfunction–associated steatotic liver disease, compensated cirrhosis, HCC requiring hepatectomy, HCC requiring non-surgical treatment, HCC requiring liver transplantation, and HCC requiring palliative care. Utilities were elicited using three direct methods: Visual Analogue Scale (VAS), Standard Gamble (SG), and Time Trade-Off (TTO), anchored at 0 (death) and 1 (perfect health). For palliative HCC, the TTO time horizon was shortened to reflect clinical realism. The order of health states and elicitation methods was randomized, and standardized training examples were provided. Mean utilities and 95% confidence intervals were estimated. Differences between methods were assessed using repeated-measures analyses, and preference heterogeneity by sociodemographic characteristics was explored. Internal validity was evaluated by quantifying logical inconsistencies, defined as instances where more severe health states were assigned higher utility values than less severe states.

Results: This study included a total of 139 adults. Utility values declined with increasing liver disease severity across all three elicitation methods. For least severe conditions, mean utilities ranged from 0.75–0.76 using VAS, 0.84–0.87 using SG, and 0.87–0.88 using TTO. Utilities decreased substantially for advanced disease, with cirrhosis valued at 0.49 (VAS), 0.73 (SG), and 0.67 (TTO), and HCC requiring palliative care valued lowest at 0.11 (VAS), 0.49 (SG), and 0.36 (TTO). Across all eight health states, SG utilities were consistently higher than TTO utilities, with mean absolute differences ranging from 0.15 to 0.33 (all p<0.001). Internal validity was high, with most participants demonstrating no logical inconsistencies in severity ordering; mean inconsistency scores were 0.15 for VAS, 0.30 for SG, and 0.45 for TTO. Subgroup analyses identified statistically significant but small differences by age, residence, income, occupation, and liver disease history. Older adults and rural respondents assigned lower utility values to advanced HCC states, particularly those requiring non-surgical or palliative treatment.

Conclusions: This study provides the first population-based utility estimates for major liver disease health states in Mongolia. The findings demonstrate expected severity gradients, systematic differences between elicitation techniques, and generally strong internal validity. These locally derived utilities will directly inform cost-effectiveness analyses of hepatitis and HCC interventions and support evidence-based cancer control policy.