OBJECTIVES: To compare the preference values for EQ-5D-5L health states between mainland Chinese and Singaporeans. METHODS: Data was from a multi-country health-state valuation study in which the preference values for 10 selected EQ-5D-5L health states were elicited from a convenience sample of mainland Chinese in Beijing (China) as well as a convenience sample of Singaporeans. Each participant self-completed 5 time trade-off (TTO) tasks, each for a different EQ-5D-5L state, using a personal computer. The difference in TTO values between mainland Chinese and Singaporeans and three subgroups of Singaporeans (i.e. English-speaking Chinese [EC], Chinese-speaking Chinese [CC], and non-Chinese [NC]) was analyzed using random-effects linear regression and logistic regression models. RESULTS: A total of 210 mainland Chinese and 207 Singaporeans provided data for this study. All 10 EQ-5D-5L health states considered, Singaporeans’ preference value was 0.146 points lower than that of mainland Chinese and the difference was consistent for all three subgroups of Singaporeans (EC: -0.156; CC: -0.195; NC: -0.073; p>0.05 for all comparisons), suggesting those health states were less valuable to Singaporeans than to mainland Chinese. Compare to mainland Chinese, Singaporeans were more likely to consider a health state as worse than being dead and consequently have a negative value to the state; the odds ratio (95% confidence interval) was 1.31(0.54-3.53) for Singaporeans as a whole, 1.41 (0.60-3.33) for EC, 1.35(0.49-3.70) for CC, and 1.11(0.50-3.13) for NC. For health states rated as worse than being dead, Singaporeans had substantial lower preference values than mainland Chinese, with the magnitude of difference being 0.399 for all, 0.383 for EC, 0.377 for CC, and 0.456 for NC (P<0.05 for all comparisons). CONCLUSIONS: It appears that health-state preferences differ between mainland Chinese and Singaporeans including Singaporean Chinese. Our study supports the practice of developing country-specific value sets for EQ-5D-5L health states.