OBJECTIVE we estimated the cost-effectiveness of a community falls prevention service compared with usual care from a National Health Service and personal social services perspective over the 12 month trial period. DESIGN a cost-effectiveness and cost utility analysis alongside a randomised controlled trial SETTING community. PARTICIPANTS people over 60 years of age living at home or in residential care who had fallen and called an emergency ambulance but were not taken to hospital. INTERVENTIONS referral to community fall prevention services or usual health and social care. MEASUREMENTS incremental cost per fall prevented and incremental cost per Quality-Adjusted Life Years (QALYs) RESULTS a total of 157 participants (82 interventions and 75 controls) were used to perform the economic evaluation. The mean difference in NHS and personal social service costs between the groups was £-1,551 per patient over 1 year (95% CI: £-5,932 to £2,829) comparing the intervention and control groups. The intervention patients experienced on average 5.34 fewer falls over 12 months (95% CI: -7.06 to -3.62). The mean difference in QALYs was 0.070 (95% CI: -0.010 to 0.150) in favour of the intervention group. CONCLUSION the community falls prevention service was estimated to be cost-effective in this high-risk group. Current Controlled Trials ISRCTN67535605. (controlled-trials.com).