Objectives A systematic review was undertaken to map what is already known about the cost effectiveness of strategies to promote safety and prevent injuries, both intentional and unintentional.

Methods A range of databases were searched, complemented by examination of grey literature, academic and government websites and a hand search of key journals. Papers were independently reviewed and cross-checked by the authors; relevant studies were coded for findings and assessed using a economic evaluation checklist.

Results More than 5000 papers were examined with more than 1100 meeting our initial inclusion criteria. The most common areas for economic analysis related to fall prevention (25%), transport safety (22%) and workplace injury prevention (21%).

Conclusions Across many areas of injury prevention, actions could be identified that were not only cost effective but often cost saving because of future costs avoided. Less is known on the economic case for complex interventions which require behavioural change to be effective. The majority of work has been undertaken in the US; a high degree of caution needs to be exercised in transferring these interventions to other contexts. There is however much scope to retrospectively adapt and add economic analysis to existing effectiveness studies of actions to prevent injuries and promote safety.