Shingles vaccine may be worth the cost of arthritis

“The vaccine initially costs more than not vaccinating. Nevertheless, our analysis suggests that the health benefits are large enough that vaccination will most likely be cost-effective,” says Gunhild Hagen.

She is a health economist at the REMEDY research center at Diakonhjemmet Hospital and the Norwegian Institute of Public Health (FHI) and first author of the study.

In addition to Diakonhjemmet Hospital and the Norwegian Institute of Public Health, the University of Oslo and the University of Innlandet have also contributed. As far as the authors know, no one has previously calculated whether the vaccine is worth the price for this group.

The vaccine must be paid for by the individual

The shingles vaccine is not part of the Norwegian vaccination program for adults. It is also not covered by any reimbursement scheme. Those who want the vaccine must therefore pay for it themselves.

The Medical Products Agency recommends that certain people receive the vaccine on prescription. This applies to people who have received or are about to receive a new organ or stem cell treatment. It also applies to people with various forms of cancer and people living with HIV.

In February 2026, the Norwegian Institute of Public Health recommended that the vaccine be included in the program for everyone from the year they turn 65. The Ministry of Health and Care Services has not yet introduced the offer.

The new study examines the economics and health associated with vaccination from the age of 50 in people with rheumatoid arthritis.

Can cause long-term pain

Herpes zoster, or shingles, is caused by the virus that causes chickenpox becoming active again later in life. The disease often causes a painful rash.

In some people, the pain continues after the rash has gone. This is called postherpetic neuralgia. The pain can lead to reduced function and quality of life.

The risk of shingles increases with age and when the immune system is weakened. People with rheumatoid arthritis, often called gout, are at increased risk. Many also take medications that suppress the immune system. This can further increase the risk.

– Shingles often goes away after a few weeks. But for some, the pain lasts much longer. Therefore, we must take into account both the disease and the consequences when calculating the benefit of the vaccine, says Hagen.

A model based on previous research

The study is not an experiment in which researchers vaccinated patients and followed them over time. It is a health economic analysis. The researchers built a calculation model using figures from previous studies and open sources.

They calculated what might happen in a group of 10,000 people. They assumed that 60 percent took the vaccine, and that all of them took both doses. The risk of shingles was taken from Swedish data on people with rheumatoid arthritis.

The researchers assumed that the vaccine protected 93 percent of those under 70 years of age and 84 percent of those over 70. They assumed that vaccination would provide 90 percent protection against long-term nerve pain. The effect was assumed to decrease by 2.5 percent each year. In addition, an analysis was done on real-world data. It suggests lower protection.

The model took into account that the risk of shingles increases with age. At the same time, protection from the vaccine may decrease. Some people will therefore get shingles even if they have been vaccinated.

What does cost-effective mean?

The researchers calculated both costs and health. The health gain was measured in quality-adjusted life years, often called QALYs.

One QALY is equivalent to one year of full health. A year of illness or pain is given a lower value, meaning that health can be gained through prevention or treatment.

At the rate used in the study, the health benefit cost around NOK 130,000 per QALY gained. This was below the limit of NOK 275,000 that the researchers used.

“Cost-effective doesn't mean that vaccination saves money. It means that the additional health is in a reasonable proportion to the additional cost,” says Hagen.

When the researchers took into account the uncertainty in the figures, vaccination was cost-effective in 98 percent of the calculations. This was true at the chosen threshold and with the assumptions in the model.

In the model, two doses of vaccination cost around 4,400 kroner.

Long-term pain matters a lot for the answer

The result was most sensitive to how many people experienced long-term nerve pain after shingles. Patients with arthritis experience long-term pain after shingles more often than otherwise healthy people. In the main analysis, the researchers assumed that this applied to 25 percent of patients with arthritis.

At the chosen threshold, vaccination was cost-effective if the risk of such pain was above 11 percent. If the risk was lower, the conclusion could be changed.

The price of the vaccine also mattered, as did its effectiveness and how quickly protection wore off.

"We need more reliable figures on how often people with arthritis get shingles and long-term pain. We also need more knowledge about how long the vaccine protects people with weakened immune systems," says Hagen.

The researchers also call for better figures for the use of healthcare services and loss of quality of life.

– The results support that vaccination from the age of 50 is considered in clinical guidelines for people with rheumatoid arthritis, says Hagen.

Facts about the study

• The study is a health economic model analysis.
• The model examined vaccination from the age of 50.
• It followed an imaginary group of 10,000 people throughout the rest of their lives.
• The model had five possible states: no shingles, shingles, long-term nerve pain, recovered from shingles, and death.
• The researchers assumed that 60 percent took the vaccine, and that they took both doses.
• Vaccination was compared with no vaccination.
• Costs and health benefits were assessed from the perspective of the health service.
• Sickness absence and production loss were not included in the analysis.
• The study was funded by the Research Council of Norway and the Olav Thon Foundation.
• The researchers declared no conflicts of interest.
• The study is published in the journal Rheumatology in September 2026.

Sources

• Journal Article | Cost-effectiveness of herpes zoster vaccination in patients with rheumatoid arthritis

Gunhild Hagen, Anna K. Opheim, Joakim Overbo, Eline Aas, Sella A. Provan

Rheumatology, Volume 65, Issue 9, September 2026, keag448, https://doi.org/10.1093/rheumatology/keag448