OBJECTIVES:  Current management of schizophrenia remains a challenge, as only about half of patients respond to their initial pharmacological regimen. Currently, prescribers have to rely on clinical judgment and patient self-report to determine the root cause of treatment failure. This lack of objective data may lead to incorrect decisions, such as overestimating adherence. Measuring anti-psychotic blood levels at the point-of-care can provide more accurate information on the root cause and thereby lead to better treatment decisions. Our objective is to estimate potential cost savings from using point-of-case plasma level testing in Spain. METHODS:  The probabilities of patients experiencing a complicated treatment course and of prescribers identifying the root cause of it correctly with and without antipsychotic levels were derived from the published literature, together with estimates for cost per case of treatment failure for Spain. A decision-analytic model was elaborated to compare annual cost of both scenarios. RESULTS:  Without information on antipsychotic plasma levels, prescribers are estimated to make incorrect decisions in 10-18% of the approximately 40% of patients with schizophrenia and complicated treatment courses, i.e., patients that do not respond to initial treatment or experience intolerable side effects to it. Based on published cost data from Spain, we estimate that the correct treatment decision would avoid €5589 per average patient, due to reduction in symptom recurrence and hospitalization. CONCLUSIONS:  Access to point of care antipsychotic plasma levels would help avoid incorrect management decisions in 10-18% of the complicated treatment courses and has the potential to improve disease management and reduce healthcare costs. The findings imply that plasma level testing in patients with complicated treatment courses would be at least cost-neutral, if the cost of a single test were up to between €1397 and €2515, assuming that correctly diagnosed patients are appropriately treated.