The True Cost of Shingles Shots

What is the true value of a vaccine: the initial cost or the expense of long-term treatment of the unvaccinated? That was the question posed by “Vaccination Against Shingles and Prevention of Long-Term Ocular Morbidity—a Retrospective Study of Cost Implications to the National Health Service (NHS) of the UK.”

According to Bita Manzouri MBBS, PhD, herpes zoster ophthalmicus affects up to 20% of patients with shingles. Most ophthalmic manifestations involve the upper eyelid and the orbit of the eye. Up to a further 25% of these cases involve patients presenting with severe complications like keratitis, uveitis, and optic nerve palsies.

Shingles is caused by the reactivation of the herpes zoster virus, which is initially acquired as chickenpox. In the UK, vaccines are available on the NHS to those older than 65, using the Shingrix vaccine that superseded Zostavax in September 2023. The former is available privately to patients older than 50 years of age.

Dr Manzouri, along with her colleagues, wanted to discover the cost implications of not vaccinating patients between the ages of 50 and 65. Would the British taxpayer save money by vaccinating more patients or simply treating ophthalmic shingles patients?

Her retrospective study of patients, conducted over 28 months (April 2022–July 2024), examined the cost of treating ophthalmic shingles patients who would have been eligible for the vaccine if the age limit was lowered to 50. The baseline of the research was that the average cost of admission to NHS hospitals was £1,699 during this period, with in-patient treatment costing £423 per day, per patient.

The cost of vaccines was given as follows: one dose of Zostavax at £99.96 for those patients treated before September 2023 (placed into Group 1), and two doses of Shingrix at a total of £320 for patients treated after that date (Group 2).

Thirty-one patients were included in Group 1 and 17 in Group 2, with an average age of 59.3 years and an average hospital visit rate of 3.8 per patient. Mean eye drops administered per patient was 2.67, and around one-fifth went on to develop complications.

The team found the total cost of treating these 48 patients on the NHS to be £42,981.98, which included attendance, imaging, and medications. When examined per group, Group 1 cost £31,396.81 and Group 2 cost £11,612.27.

For the same cost as Group 1, 314 people could have been vaccinated against shingles and 36 people for Group 2. Dr Manzouri pointed out this does not include the added costs of lost time at work and treating the complications of the disease.

Dr Manzouri concluded that lowering the minimum age of the shingle vaccine to 50 would be more cost-effective for the NHS. This is especially important, she said, as the potential introduction of a chickenpox vaccine could reduce adult immunity to shingles.

Dr Manzouri presented at the 2025 EuCornea congress in Prague.

Bita Manzouri BSc, MBBS, MRCP, FRCOphth, PhD is a consultant corneal and cataract surgeon at Queen’s Hospital Romford, Essex, UK. bita.manzouri@nhs.net