OBJECTIVES Most elderly prefer to grow old in the community within a familiar environment, instead of moving to a nursing home. Preventive home visits based on multidimensional geriatric assessment can be one strategy to support this preference and might additionally reduce health care costs, due to the avoidance of costly nursing home admissions. The purpose of this study was to analyse the cost-effectiveness of preventive home visits from a societal perspective in Germany. METHODS This study is part of a multi-centre, non-blinded, randomised controlled trial. Participants were older than 80 years and living at home. Three home visits were conducted to identify self-care deficits and risk factors, to present recommendations and to implement solutions. The control group received usual care. A cost-utility analysis using QALY based on the EQ-5D was performed. A cost-effectiveness acceptability curve controlled for confounding variables was constructed. A sensitivity analysis to control for the influence of the mode of QALY calculation was performed. RESULTS CONCLUSIONS We found convincing evidence that the evaluated preventive home visits programme is not cost-effective.