Background: Falls in the elderly represent a public health crisis. Effective prevention programs need to conduct economic analyses. The Move With Balance program showed a 65% reduction in falls in institutionalized elderly. Methods: We evaluated the return on investment (ROI) of Move With Balance. We calculated the ROI for 2 situations: first, using data from the current study (N = 27); second, extrapolating the data to an “intended” annual program (N = 45) where training costs can be spread over 6 years. Results: The program costs for the current study was $11,143. Based on an efficacy rate of 65%, we estimated that 13 falls were averted among the 21 participants in the treatment group. At a cost of $1440/fall, total averted cost of falls was $18,720. The ROI was 1.7:1 for a 10-week period. Program effects persisted for at least 6 months. Extrapolating the current program costs and fall rates to include classes for 45 people twice a year, the annual program costs would be $27,217. Total annual averted cost of falls would be $208,594. The annual ROI in this group would be 7.6:1. Conclusions: Move With Balance not only is efficacious in reducing falls in institutionalized elderly but also has a positive ROI.