OBJECTIVES The aim of this study was to assess the cost-effectiveness of HZ vaccination compared to  no vaccination strategy which only involves the treatment of patients affected by HZ, within the Italian context.  METHODS The natural history of HZ and PHN was mapped through a Markov model with lifetime horizon and cycles lasting one month. Both third party payer (the Italian National Health Service) and societal perspectives were adopted. Costs and Effectiveness data was derived from literature and discounted by 3.5%. Model results are expressed in terms of incremental cost-effectiveness ratio (ICER). Both deterministic and probabilistic sensitivity analyses were performed to appraise the effect of parameters’ variation on model results. RESULTS A population of patients with HZ aged between 60 and 79 years was hypothesized. The ICER of the vaccination equaled € 12,155 per QALY under the NHS perspective and € 11,118 per QALY under the societal perspective. Moreover, under NHS perspective the cost per HZ-episode avoided and the cost per PHN-episode avoided amounted to € 1,098 and € 8,742 respectively. Considering a cost-effectiveness threshold of €30,000/QALY, the probabilistic sensitivity analysis showed that vaccination is cost-effective regardless of the perspective adopted, in 99% of simulations.  CONCLUSIONS Results showed that a vaccination program against herpes zoster and post-herpetic neuralgia is cost-effective in Italian patients aged between 60 and 79 years.