Evaluating Mongolia's Sugar-Sweetened Beverage Tax: A Cost-Effectiveness Analysis

Mongolia has approved a tax of 20% on sugar-sweetened beverages (SSBs) to take effect in 2027, yet while prior work has assessed potential health impacts, no peer-reviewed study has evaluated its cost-effectiveness.

This study evaluates the cost-effectiveness of Mongolia's planned SSB tax by estimating its effect on health outcomes, healthcare costs, and changes in SSB consumption patterns.

Using a Markov cohort model, we project outcomes over 10-year, 20-year and lifetime horizons. The model incorporates changes in the prevalence of overweight and obesity, noncommunicable disease (NCD) incidence, and associated costs, with primary outcomes measured in disability-adjusted life years (DALYs) averted, and quality-adjusted life years (QALYs) gained. To improve precision, disease risk estimates are informed by biomarker data, such as blood sugar and lipid levels, minimizing reliance on self-reported health indicators.

The ad valorem tax of 20% is projected to reduce consumption of SSBs by 31% through consumer price response alone. Accounting for additional calorie reductions from 20% industry reformulation, the combined effective reduction in SSB-related energy intake reaches approximately 45%. Across the three time horizons, the tax could avert 13, 260 and 2255 premature deaths; yield 2899, 14,362 and 33,613 QALYs; and avert US$6.13 million, US$30.34 million and US$71.02 million, respectively, in healthcare costs. From the healthcare perspective, the tax is cost-effective over 10 years (net cost US$1.77 million; incremental cost-effectiveness ratio (ICER) US$611.99/QALY) and becomes cost-saving within 20 years and over the lifetime horizon.

These findings support the implementation of the SSB tax as a strategy to reduce Mongolia's NCD burden and generate long-term fiscal and health benefits.