OBJECTIVES: Herpes Zoster (HZ) is a painful disease resulting from reactivation of the varicella-zoster virus which can cause post-herpetic neuralgia (PHN), a debilitating pain persisting from three months to years after rash onset. The incidence and severity associated with HZ negatively impacts functional status and quality of life and increases with advancing age. A vaccine preventing HZ and PHN in people aged 50 and more will soon be available in Europe. This study aimed to assess the cost-effectiveness of zoster vaccination in France. METHODS: A published Markov model was adapted to the French setting. Cost-effectiveness of vaccinating 20% of individuals aged 70-79 was evaluated over lifetime from a national health care perspective. Base case analysis considered French epidemiological, economic and EQ-5D based utility data. The analysis assumed a waning vaccine efficacy of 4.15% annually as suggested by clinical data. A discount of 4% was applied to costs and outcomes over the first 30 years and a 2% rate thereafter. Extensive sensitivity analyses were performed on factors of influence described in the literature. RESULTS: Incremental cost-effectiveness ratios were estimated at 9,693€ per QALY gained, 1,529€ per avoided HZ case and 3,480€ per avoided PHN case. The probability that the ICERs were below €28,000 to €84,000/QALY (one to three times the GDP per capita) were greater than 92% and 95%, respectively. Univariate sensitivity analysis confirmed the favorable cost-effectiveness profile, ranging from 5,793 to 19,565€/QALY gained. Duration of protection and utility estimates were the most impactful parameters. Vaccination policy targeting other cohorts, such as people aged 65 years-old was also found cost-effective, with an ICER estimated at 7,217€/QALY gained. CONCLUSIONS: Beyond epidemiological and clinical evidence, health-economic evidence supports the implementation of a zoster vaccination policy in the French senior population aged 70 and over.