 The study compares the cost-effectiveness of a girls-only and gender-neutral vaccination program with 9vhpv to the current vaccination program in Spain, using a dynamic transmission model simulating the natural history of HPV infections and a pair perspective. The results show that a girls-only vaccination strategy at age 12 years with 9vhpv is cost-effective compared with 4vhpv, while gender-neutral vaccination with 9vhpv leads to further reductions of up to 28.5% in the incidence of cervical intraepithelial neoplasia, CIN, two-thirds and 17.1% in the incidence of cervical cancer, as well as a 14% reduction in cervical cancer mortality. A gender-neutral vaccination program with 9vhpv could potentially be cost-effective considering some parameters as head and neck protection or discount rates, leading to a reduction in the burden of HPV-related diseases in both sexes in the Spanish population. This article was offered by Jesus de la Fuente, Juan Jose Hernandez Oguado, Maria San Martín, and others. We are article.tv, links in the description below.