연구배경: Current national immunization program (NIP) in Korea includes bivalent and quadrivalent human papillomavirus (2vHPV, 4vHPV) vaccination of 12-year-old girls. Several countries have included HPV vaccination of both boys and girls, i.e. gender-neutral vaccination (GNV) to their NIPs. The objective of this study was to assess the cost effectiveness and public health impact of HPV vaccination program for 12-year-old GNV, compared with screening without vaccination and current NIP HPV vaccination program for girls only in Korea. 대상 및 방법: We adopted a previously validated dynamic transmission model with a 100-year time horizon to assess the cost effectiveness and public health impact of 12-year-old GNV 4vHPV vaccination. We assumed 60% and 30% vaccine coverage in 12-year-old girls and boys, respectively, two dose schedule and lifelong protection through herd immunity. Incidence rates, cost-per-case, utility weights and inputs were based on peer-reviewed literature. The HPV-associated outcomes assessed were cervical intraepithelial neoplasia (CIN), genital warts, recurrent respiratory papillomatosis (RRP), and cervical, vaginal, vulvar, anal, oropharyngeal, and penile cancers. The incremental cost-effectiveness ratio (ICER) was estimated as the ratio of incremental costs to incremental quality-adjusted life years (QALYs). 결과: When including all HPV-associated outcomes in the analysis, the ICER of 4vHPV GNV compared with screening without vaccination was 4.4 million KRW/QALY and 1.1 million KRW/QALY at a 3% and 1% discount rate, respectively. The ICER of 4vHPV GNV was 6.2 million KRW/QALY and 2.6 million KRW/QLAY at 3% and 1% discount rate, compared with 2vHPV vaccination for 12-year-old girls. When compared with 4vHPV vaccination for 12-year-old girls, 4vHPV GNV was 29.9 million KRW/QALY and 15.5 million KRW/QALY at a 3% and 1% discount rate, respectively. We also confirmed that 4vHPV GNV reduced HPV-associated cost by 52,672 million KRW compared to 4vHPV vaccination for 12-year-old girls. During a 100-year time horizon, 4vHPV GNV resulted in an estimated reduction of 9,233, 15,380, and 7,506 cases of CIN1, CIN2/3 and HPV associated cancers, respectively, compared with both 2vHPV and 4vHPV girls only vaccination (Table 1). In addition, it resulted in reduction of 3,114,530 and 377,810 cases of genital warts compared to 2vHPV, and 4vHPv girls only vaccination. 결론: Model-based analysis suggests that 4vHPV gender-neutral vaccination program was cost-effectiveness compared with both, screening without vaccination and current NIP in Korea. GNV program would provide equitable protection for boys against HPV-related disease through direct protection and additional protection for girls through herd immunity. Potential for GNV to be more resilient needs to be studied further.