In-hospital falls represent significant health and economic concerns, but previous studies regarding the economic cost of falls do not account for other cofounders (comorbidities and clinical aspects) in this cost evaluation. The aim of this study is to analyse the cost of in-hospital falls comparing those who had falls to nonfalls patients while accounting for several risk factors associated with falls. Data were collected from January 2020 to December 2022, in a private hospital in Brazil. The sample was divided into two groups: one with patients who fell and the other with nonfallers on a 1:2 ratio, and these groups were matched to avoid confounding variables. The median cost for patients who experienced falls was US$7520.26 compared to US$6144.24 for those without falls (p < 0.01). This trend was especially marked in men aged 20-40 who suffered falls and showed a significantly elevated median cost of US$29 722.02 distinguishing them from those without falls with a median cost of US$1179.48 (p < 0.01). Hospital falls significantly increase financial costs compared to nonfall cases, irrespective of comorbidities, length of stay or case-mix variations. The findings recommend a universal precautions approach to fall prevention in hospitals, targeting all hospitalised patients to effectively minimise the economic burden associated with in-hospital falls.