OBJECTIVES: Schizophrenia is a mental disease of chronic nature that may often require long time hospitalizations to be controlled. One of the major issues in controlling Sc is adherence to treatment. Long-term release paliperidone palmitate administered intramuscularly once a month improved treatment compliance and diminished hospitalization rates. Our goal was to estimate the costs of hospitalization for schizophrenic patients in Brazil (private setting) and to calculate the monetary impact of adopting LRPP in an outpatient scenario. METHODS: We searched a database of claims of five health plans in order to identify patients with schizophrenia. Then, we retrieved all hospitals bills for each patient and determined the final cost of admissions. Only direct costs were considered: medication, medical visits, ancillary fees, etc. To project the impact of the adoption of LRPP, we estimated that hospitalization rates would be reduced by 31.5% for patients admitted for less than one year and 35.9% for those hospitalized for up to two years, according to data from randomized trials.  RESULTS: We identified 18 admissions due to schizophrenia. Patients had a mean age of 43.4 years. Mean length of hospitalization was 126.4 days, corresponding to a total of 2275 days for all patients. Total hospitalization cost was R$ 604 889 (US$ 252 037), mean of R$ 33 604 (US$ 14 000) per hospitalization. If LRPP was adopted, the cost to treat these patients would be cut down to R$ 130 974 (US$ 54 572), a reduction of 21,65%.  CONCLUSIONS: Based on real world data, Sc hospitalization costs may be reduced by 21% if outpatient treatment with LRPP is adopted.