OBJECTIVES: To estimate the economic cost of road traffic injuries in Belize. METHODS: A cross-sectional study was conducted using secondary cost data and assuming the health system and social perspectives. Two major databases were analyzed: the mortality database, containing all deaths during 2001-2007, and the national hospital discharge database, containing all discharges during 2007. Additionally, a third database containing all emergency ambulance services provided by BERT to persons involved in RTI in the Belize District during 2007 was analyzed. A descriptive analysis was performed for all databases. Central tendency and dispersion measures were calculated for the continuous variable (mean, median, standard deviation, maximum and minimum value) as well as frequencies and percentages for the categorical variables. Costing was done in 2007 Belize Dollars after adjusting by inflation using the Belize National Consumer Price Index. Costs were also discounted at an annual rate of 3% and 5%. Multi-way sensitivity analysis was carried out in order to incorporate uncertainty in the estimations. RESULTS: A total of 63 (or 61 if adjusted) people died as a consequence of RTI during 2007 (a mortality rate of 20.72 deaths per 100,000 inhabitants), 338 were hospitalized and a total of 565 slightly injured was estimated. A total of 2,501 Years of Potential Life were Lost in Belize due to premature death. All this translated in a total economic cost of BZ$31,966,045 due to RTI during 2007. This figure represents 1.26% of Belizean GDP during 2007. The great majority of the cost is for fatal injuries, specifically on indirect cost attributed to premature death. Direct cost was estimated at BZ$491,549, of which 2.09% was spent on fatalities, 61.61% on severely injured and 36.30% on slightly injured. CONCLUSIONS: The economic cost estimations make clear the need to prevent RTI utilizing a strategic and multisectoral approach that focuses on addressing the main problems identified.