OBJECTIVES: To evaluate cost-utility of amisulpride compared with first generation antipsychotics (FGA) in treatment of schizophrenia in adult patients in Poland. METHODS: A decision-tree model was used to estimate utilities and costs of treatment of amisulpride therapy in comparison to FGA (antipsychotics, management of main antipsychotics’ adverse events - extrapyramidal symptoms’ (EPS) and health care costs). The FGA group included the following drugs: haloperidol, perazine and flupenthixol. Analysis was performed from the National Health Fund (NHF) perspective with a time horizon of 1 year. The range of possible events in the model included: therapy discontinuation (regardless of reason), EPS occurrence, schizophrenia relapse and suicide. Range of events was assumed to be the same for amisulpride and FGA but probabilities of those events varied between antipsychotics. Based on systematic review of RCTs amisulpride is more effective than FGA in terms of compliance rate and in reduction of both the risk of relapse and occurrence of EPS. A probabilistic sensitivity analysis was performed to estimate the probability that amisulpride is cost effective in Polish conditions (threshold about 100,000 PLN/QALY). RESULTS: From the NHF perspective amisulpride compared with FGA was more effective (ΔQALY = 0.004) and it was cheaper (comparing to flupenthixol) or cost-effective (ICUR=1 079/QALY PLN and ICUR=31 810/QALY PLN in comparison to haloperidol and perazine, respectively). The calculated probability that amisulpride is more effective than any of FGA was 100%, while the probability that it is also cost-effective varied between 68% for perazine to 83% for flupenthixol. CONCLUSIONS: Treatment of schizophrenia with amisulpride is a cost-effective option in comparison to FGA in Poland. The obtained difference in QALY is very small, but reduced risk of relapse and necessity of hospitalization due to better effectiveness of amisulpride and reduced occurrence of EPS results in a better cost benefit outcome for amisulpride compared to  FGA.