OBJECTIVES:  Aripiprazol is a dopamine-serotonine system stabilizer not included in the standard treatment of schizophrenia in Brazil´s universal health system. It has been the reason of many court orders demanding its supply. This study proposes a systematic review with meta-analysis of the efficacy, safety and cost-effectiveness of aripiprazole compared to olanzapine, a standard drug for schizophrenia in Brazil, to evaluate the rationality of its use for the treatment of schizophrenia. METHODS:  A systematic review was conducted in accordance to the Cochrane Handbook guidelines, including RCTs and complete economic evaluations. A eletronic search in the databases of Medline, The Cochrane Library and Lilacs and a complementary search in theses and dissertations databases, scientific journals, and abstracts of international meetings were conducted. Results of independent studies were combined via meta-analysis. RESULTS:  Six RCTs and ten economic evaluations were included. None of the studies showed efficacy results that significantly favored aripiprazole and two studies significantly favored olanzapine. Most studies did not show difference between olanzapine and aripiprazole regarding neurological adverse effects. One paper reported a better neurological adverse effects profile for olanzapine. All six studies found worse metabolic profile for olanzapine. The meta-analysis of aripiprazole in comparison with olanzapine showed that patients in use of aripiprazole are more likely to discontinue treatment (RR[IC95%]=1.15[1.06-1.24]; I=0%; p-value<0.0009) and less likely to have weight gain >7% (RR[IC95%]=0.44[0.25-0.55]; I=0%; p-value<0.00001). Olanzapine was found dominant in seven economic evaluation studies and aripiprazole was dominant in two. In one study, aripiprazole was less expensive and less effective than olanzapine (RCEI of 3,951.72 €/remission). CONCLUSIONS: Aripiprazole was not found to be a better therapeutic alternative than olanzapine. But, despite of being less efficacious and show worse cost-effectiveness profile, aripiprazole might be useful for patients that were considered irresponsive or intolerant to olanzapine.