OBJECTIVES: In Germany, about 500,000 people suffer from Schizophrenia. Due to its chronic relapsing course that involves fundamental functional and social impairment, schizophrenia has emerged as a dominant burden to society. However, studies to determine the economic consequences of the disease have largely been carried out in clinical settings based on a relatively small number of cases. Therefore we aim to assess the medical and non-medical consequences of schizophrenia as well as the cost structure across treatment settings and population characteristics using administrative data. METHODS: Costs attributable to Schizophrenia were estimated using a case-control design, where 26,294 patients drawn from a sickness fund administrative database were matched to 9,319 patients with a confirmed diagnosis of schizophrenia (ICD-10: F20). To obtain balance between both groups in a set of observed pre-treatment variables (age, sex, prior number of drug prescriptions, Elixhauser comorbidities) and to reduce the conditional bias, a genetic matching algorithm was employed. Eventually, costs and other health care resource utilization parameters for cases and controls were recorded during 2008. RESULTS: The annual cost attributable to Schizophrenia amounts to € 10610 per patient from the payer’s perspective, and € 19927 from the societal perspective. Lost productivity (46.6%), inpatient treatment (29.0%) and nursing care (14.3%) are the major cost drivers of the disease. The burden of disease of Schizophrenia in Germany is estimated to be approximately € 5220 million per year from the sickness fund perspective and € 9804 million from the societal perspective. CONCLUSIONS: While our calculations still underestimate the true burden of disease due to restricting quality of life to production forgone and due to ignoring the impact on family members, considerable direct and indirect costs of schizophrenia highlight the need for further research in order to improve care patterns and to find innovate treatment solutions.