---
title: A model built on Korean data says vaccinating boys clears Korea's cost-effectiveness threshold. The national programme still vaccinates girls only
publication: Medical Insights Korea
section: news
category: Sexual Health
canonical_url: https://medicalinsightskorea.com/news/korea-hpv-vaccination-girls-only-cost-effectiveness
author: Andrew Cho
published: 2026-10-01T09:00:00+09:00
modified: 2026-10-01T09:00:00+09:00
content_type: reporting
license: Quotation permitted with attribution to Medical Insights Korea and a link to the canonical URL.
---

# A model built on Korean data says vaccinating boys clears Korea's cost-effectiveness threshold. The national programme still vaccinates girls only

Six of the model's seven authors work for the vaccine manufacturer. The professional society that has revised its guidance four times in a decade does not.

## Answer

A dynamic transmission model adapted to the South Korean population projected that vaccinating both girls and boys with the nonavalent HPV vaccine, against the currently administered programme of vaccinating girls only with the quadrivalent vaccine, would prevent 36,248 cervical cancers and 9,313 cervical cancer deaths in women and 666,182 genital warts, 2,441 head and neck cancers and 995 anal cancers in men over 100 years, at an incremental cost-effectiveness ratio of 38.9 million won per quality-adjusted life year — which the authors describe as below the accepted threshold in South Korea.

## Key takeaways

- The programme currently administered in South Korea vaccinates girls only, using the quadrivalent HPV vaccine.
- A dynamic transmission model adapted to the Korean population projected that gender-neutral nonavalent vaccination would prevent 1,282,415 cases of CIN1, 918,384 of CIN2/3, 36,248 cervical cancers and 9,313 cervical cancer deaths in women over 100 years.
- In men the same change was projected to prevent 666,182 genital warts, 7,422 cases of recurrent respiratory papillomatosis, 2,441 head and neck cancers, 995 anal cancers and 122 penile cancers.
- The incremental cost-effectiveness ratio was 38.9 million won per quality-adjusted life year, described by the authors as below the accepted cost-effectiveness threshold in South Korea.
- The Korean Society of Gynecologic Oncology has revised its HPV vaccination guidance in 2016, 2019, 2021 and again in its latest version, which focuses on the necessity of vaccination in middle-aged men.

## Full article

Immunisation policy usually lags evidence, and the gap is normally argued over in general terms. In this case the argument has been made in Korean numbers, against the Korean programme, using Korea's own cost-effectiveness threshold — and published.

### The comparison the model ran

An established dynamic transmission model of HPV epidemiology was adapted to the South Korean population. It compared vaccinating girls and boys with the nonavalent vaccine against the programme currently administered, which vaccinates girls only with the quadrivalent vaccine.

**Cases projected to be prevented over 100 years by gender-neutral nonavalent vaccination, South Korea**

| Outcome | In women | In men |
| --- | --- | --- |
| CIN1 | 1,282,415 | — |
| CIN2/3 | 918,384 | — |
| Cervical cancer | 36,248 | — |
| Cervical cancer deaths | 9,313 | — |
| Genital warts | 14.6% reduction | 666,182 |
| Recurrent respiratory papillomatosis | 15.8% reduction | 7,422 |
| Head and neck cancer | — | 2,441 |
| Anal cancer | — | 995 |
| Penile cancer | — | 122 |

Reductions of 4.8 to 8.2 percent were also projected in HPV-related vaginal, vulvar, anal and head and neck cancers in women.

**₩38.9m per QALY** — incremental cost-effectiveness ratio of gender-neutral nonavalent vaccination against the current girls-only quadrivalent programme, which the authors state is below the accepted threshold in South Korea  
_Source: Bae S et al., Human Vaccines & Immunotherapeutics, 2025_

> **Who produced this model**  
> Six of the study's seven authors are employed by the manufacturer of the nonavalent vaccine — MSD Korea, Merck & Co. in Rahway, New Jersey, and MSD Thailand — across market access, global medical affairs, outcomes research and health economics. The first author is a urologist at Uijeongbu St Mary's Hospital. Manufacturer-sponsored modelling is standard in this field and is not a reason to discard the work, and it is a reason to read the assumptions rather than the conclusion, because the party that chose them sells the product the model recommends.

> **The comparison changes two things at once**  
> The model adds boys and upgrades the vaccine in the same step. Much of the projected benefit in women follows from the nonavalent vaccine covering more genotypes, not from vaccinating men. The male figures are attributable to vaccinating men; the cost-effectiveness ratio belongs to the combined change and is not the price of adding boys to the programme as it stands.

### Professional guidance has moved four times

The Korean Society of Gynecologic Oncology first issued HPV vaccination guidelines tailored to Korea in 2016. It revised them in 2019 after the nonavalent vaccine became available, and again in 2021 to add recommendations for middle-aged women and men and for vaccination after conisation.

Its latest revision focuses on the necessity of vaccination in middle-aged men, states a position on the single-dose schedule the World Health Organization now recommends, addresses additional nonavalent vaccination for people previously given the bivalent or quadrivalent vaccine, and updates the evidence for two doses at ages 9 to 14.

Four revisions in a decade, each widening the recommended population, against a national programme whose scope has not changed, is the shape of an unresolved policy question rather than a settled one.

### What the vaccine would not cover

Among 44,065 Korean men tested for HPV between 2014 and 2022, overall positivity was 59.1 percent. HPV 6 was the most common low-risk type at 33.3 percent and HPV 11 next at 11.0 percent; HPV 16 dominated high-risk infection at 5.2 percent. Just under half of positive men — 49.3 percent — carried more than one genotype.

High-risk genotypes outside the nonavalent vaccine's nine types, principally HPV 53, 51, 39 and 66, accounted for between 27.6 and 35.0 percent of infections annually. The authors of that study conclude the data supports including males in national vaccination strategies with the current nonavalent vaccine, and that genotype surveillance needs to continue.

### What this does not establish

1. A model is a projection under assumptions, not a measurement. Its outputs depend on the transmission parameters, coverage assumptions and time horizon chosen, and a 100-year horizon accumulates benefit that a shorter one would not.
2. The cost-effectiveness ratio applies to a combined change of vaccine and target population and cannot be read as the incremental cost of adding boys alone.
3. Cost-effectiveness is one input to immunisation policy. Budget impact, vaccine supply, delivery capacity and competing programmes are others, and none of them appear in this figure.
4. Six of the seven authors are employed by the vaccine manufacturer. That does not make the model wrong, and it does mean the assumptions were chosen by a party with an interest in the result.
5. The genotype study covers men who presented for HPV testing, a group already more likely to be positive than the general population.
6. None of this describes what an individual should do, which is a separate question this publication covers separately.

What is on the record is that the case for vaccinating Korean men has been modelled on Korean data, cleared the threshold Korea uses to judge such things, and been echoed by the relevant professional society across four revisions — and that the national programme, as the model itself describes it, still vaccinates girls only.

## Sources

- Bae S, Park JH, Oh S, Yang G, Wang WV, Pavelyev A, Sukarom I. Public health impact and cost-effectiveness of implementing gender-neutral immunization with the nonavalent human papillomavirus vaccine in South Korea. Human Vaccines & Immunotherapeutics 2025;21(1):2582299. doi:10.1080/21645515.2025.2582299. PMID:41371993. https://doi.org/10.1080/21645515.2025.2582299
- Lim H, Kim SI, Min KJ, Lee JK, Kim JW, Lee TS. Updated clinical practice guidelines for human papillomavirus vaccination: the Korean Society of Gynecologic Oncology recommendations. Journal of Gynecologic Oncology 2026;37(2):e71. doi:10.3802/jgo.2026.37.e71. PMID:41775253. https://doi.org/10.3802/jgo.2026.37.e71
- Jo SB, Ahn ST, Kim JW, Oh MM, Lee DS, Sohn YH, Moon DG. Prevalence and genotype distribution of human papillomavirus among Korean males: Implications for vaccination strategies. Investigative and Clinical Urology 2026;67(1):62-71. doi:10.4111/icu.20250223. PMID:41469907. https://doi.org/10.4111/icu.20250223

## Citation

Andrew Cho (2026). "A model built on Korean data says vaccinating boys clears Korea's cost-effectiveness threshold. The national programme still vaccinates girls only". Medical Insights Korea. https://medicalinsightskorea.com/news/korea-hpv-vaccination-girls-only-cost-effectiveness

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