OBJECTIVES: Describe estimated health resource (HR) and criminal justice (CJ) system costs by treatment failure status for young patients with schizophrenia that participated in the Paliperidone palmitate Research In Demonstrating Effectiveness (PRIDE) clinical trial involving recently incarcerated subjects. METHODS: HR and CJ events were collected via a resource use questionnaire and were combined with cost estimates obtained from administrative claims and published literature to estimate costs at 15 months (trial duration).  Treatment failure was defined in the clinical trial as having any of the following: an arrest/incarceration, psychiatric hospitalization, suicide, discontinuation of antipsychotic treatment due to inadequate efficacy, treatment supplementation with another antipsychotic due to inadequate efficacy, discontinuation of antipsychotic treatment due to safety or tolerability, or increase in the level of psychiatric services in order to prevent imminent psychiatric hospitalization. Costs, in 2011 US dollars, were estimated by failure status (Yes/No) for young subjects (defined as those ≤35 years of age) and summarized descriptively using a state government payer perspective. RESULTS: Estimated cost per person for young subjects with a failure (n=104) were $45,590 versus $24,586 for young subjects without a failure (n=57).  Cost differences were greater for the failure group relative to no failure group for criminal justice system events ($20,961) acute care events ($4,722) and outpatient care ($524).  Within the failure group, extrapolating out to the 15 month trial duration, criminal justice system events were a common cause of failure in this analysis with an estimated 86.5% expected to have a criminal justice system contact and 70.2% expected to be incarcerated. CONCLUSIONS: From a state government perspective, provision of early interventions that reduce treatment failure among young patients may avoid substantial cost.