OBJECTIVES: Patients with schizophrenia experience elevated rates of morbidity and mortality, largely due to an increased incidence of cardiovascular disease and diabetes. The STAR study showed that the metabolic side effects of aripiprazole treatment are less than that experienced by those receiving standard-of-care (SOC) antipsychotic treatment (olanzapine, queatipine or risperidone). This study estimates the difference in direct and indirect cost-consequences of diabetes and coronary heart disease (CHD) in schizophrenia patients treated with aripiprazole or SOC. METHODS: On the basis of the results provided by the STAR study, risks for diabetes and CHD were projected over a time horizon of 10 years in the Spanish setting using the Stern and Framingham models. The comparators were aripiprazole versus SOC. The prevalence and costs (direct and indirect) of diabetes and CHD were obtained from Spanish sources. All costs were inflated to 2009 costs using the Spanish Health System pay and prices index. RESULTS: The number of avoided diabetes cases (23.4 cases per 1,000 treated patients) in patients treated with aripiprazole compared to SOC was associated with estimated total (direct and indirect) cost saving of €27,798,018 over 10 years for the Spanish population. Similarly, with aripiprazole the number of avoided CHD events (3.7 events per 1,000 treated patients) yields an estimated total cost saving of €4,173,818 over 10 years. CONCLUSIONS: Compared with SOC, aripiprazole treatment can significantly reduce the number of diabetes and CHD events. As a consequence, it can provide considerable reductions in the health and economic burden to schizophrenia patients and health care services in the Spanish setting due to its favourable metabolic profile.