Background: hospital falls place a substantial burden on healthcare systems. There has been limited research into the use of hospital flooring as an intervention against fall-related injuries. Objective: to assess the cost-effectiveness of shock-absorbing flooring compared with standard hospital flooring in hospital wards for older people. Design: a cost–utility analysis was undertaken drawing upon data collected in a pilot cluster randomised controlled trial and the wider literature. Setting: the trial included eight hospital sites across England. Four sites installed shock-absorbing flooring in one bay, and four maintained their standard flooring. Measurements: falls and resulting injuries and treatment were reported by hospital staff. Data on destination of discharge were collected. Patients were followed up at 3 months and further resource use data were collected. Health-related quality of life was assessed, allowing quality-adjusted life years (QALYs) to be estimated. The incremental cost-effectiveness ratio of the shock-absorbing flooring was assessed compared with the standard hospital flooring. Results: in the base case, the shock-absorbing flooring was cost saving, but generated QALY losses due to an increase in the faller rate reported in the intervention arm. Scenario analysis showed that if the shock-absorbing flooring does not increase the faller rate it is likely to represent a dominant economic strategy—generating cost savings and QALY gains. Conclusion: the shock-absorbing flooring intervention has the potential to be cost-effective but further research is required on whether the intervention flooring results in a higher faller rate than standard flooring.