OBJECTIVES: To conduct a cost-utility analysis by estimating incremental cost effectiveness ratio (ICER) of ulipristal acetate (UA) 5mg in patients with reproductive age of 18-50, who can undergo fibroid surgery as alternative of GnRH-agonists in Korea. METHODS: Markov model was developed to assess cost-utility of UA for duration of 3 months. Leuprolide acetate (LA) 3.75mg, a GnRH-agonist was selected as an alternative of UA 5mg. The effectiveness of UA was estimated by quality adjusted life years (QALYs) and the cost-utility analysis was performed in the view of limited society perspective. Costs were counted at price of 2016. The clinical data were obtained from PEARL II Study which was used to estimate the transition probabilities of health states of Markov model. Utilities for each health states were measured using standard gamble (SG) method. Probabilistic sensitivity analysis was performed with 1000 replications of the simulation. RESULTS: No significant difference on effectiveness was found between UA and LA treatment in controlling menorrhagia. However, UA appeared to reach the controlled menorrhagia health state significantly faster compared to LA statistically (p<0.001). UA treatment appeared to have a ‘moderate or severe hot flash’ morbidity rate of 11%, while LA treatment had morbidity rate of 40% (P<0.001). This results showed that UA treatment had significantly low adverse events compared to LA treatment which is very fatal to patients’ quality of life. ICER was estimated with an incremental cost of ₩116,979 and 0.0125 incremental QALYs, which resulted to ₩9,372,003/QALYs. The mean ICER in the probabilistic sensitivity analysis was appeared to be ₩8,201,210/QALYs (95% C.I. 2,794,395 - 17,033,279). CONCLUSIONS: UA is a cost-effective treatment with significant improvement in quality of life in uterine fibroid patients compared to GnRH-agonists.