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Water use efficiency (WUE) is one of the most widely used indicators in agricultural water management. Although this indicator has obvious advantages, it is limited to measuring the relationship between crop yield and corresponding water use. In recent years, many researchers have noted that understanding the economic efficiency of water use (EEWU) could have great water-saving potential, while it has been poorly investigated with respect to China’s agricultural water management. This paper assesses EEWU through a household farmer-level survey in the piedmont region of North China. First, EEWU of crops are estimated based on agricultural water consumption (including irrigation water and effective precipitation) and profit (including gross profit and net profit); Second, the impact of monthly price changes in 2019 and annual price changes in 2014–2019 on EEWU is analysed. Main conclusions are as follows: (1) EEWU values of cash crops such as apple and cauliflower are much higher than those of grain crops such as wheat and maize; (2) For different crops, the median economic efficiency of irrigation water (EEWiU) and total water (EEWtU) range from 31.71 to 99.54 ¥/m3 and 11.31 to 44.05 ¥/m3, respectively; (3) The multi-year average EEWiU and EEWtU ranged from 4.75 to 63.99 ¥/m3 and from 2.67 to 31.71 ¥/m3, respectively. Economic efficiency of water use shows a slightly downward trend in the period of study, which would contradict the trend towards the use of more water-efficient technologies and shows an even larger margin of improvement in the domain of agricultural water efficiency. The results provide a powerful reference for the management of agricultural water use through economic leverage.