OBJECTIVES: The Zostavax Vaccine is recommended by the Advisory Community on Immunization Practices for the prevention of herpes zoster in adults at least 60 years old.  Uptake of the vaccine is suboptimal as approximately 25% of seniors receive the vaccine as recommended.  The objective of this project was to evaluate the cost-effectiveness of a multifaceted community pharmacy intervention designed to increase herpes zoster vaccinations. METHODS: A Markov model was constructed to estimate the cost-effectiveness of implementing a multifaceted community pharmacy intervention when compared with no formal promotion.  A lifetime horizon was utilized to estimate the direct costs associated with vaccination and treatment of herpes zoster and number of cases of herpes zoster occurring under each program. The analysis assumed a healthcare perspective. RESULTS: For a cohort of 100,000 60 year olds with no formal vaccination program, 16,030.1 cases of herpes zoster would be expected to occur over the lifetime of the cohort with an associated $27,787,515 in costs for vaccination and treatment of herpes zoster. For a cohort of 100,000 60 year olds receiving a month long community pharmacy intervention to promote herpes zoster vaccination, there would be a projected 16,028.8 cases of herpes zoster with $27,812,520 in associated costs for vaccination and treatment of the disease.  The resulting incremental cost-effectiveness ratio associated with each additional case of herpes zoster prevented with community pharmacy promotion of herpes zoster was estimated at $19,235. CONCLUSIONS: A month long community pharmacy oriented intervention resulted in a modest reduction in the number of herpes zoster cases occurring and a modest increase in costs.  Future studies may consider examining the impact of extended periods of promotion.