OBJECTIVES: Sertindole is an atypical antipsychotic medication in schizophrenia. It has a good tolerability profile likely to favor long-term adherence, reductions in relapse and re-hospitalization rates, and improvements in quality of life. This study assessed the cost effectiveness of antipsychotics in South Korean setting. METHODS: A Markov model was developed to estimate the cost-effectiveness of sertindole compared with risperidone, olanzapine and quetiapine in the management of chronic schizophrenia over a five-year period. Patients entered the model upon experiencing intolerance to their antipsychotic treatment during an episode of acute psychopathology. Confounding factors included drug-induced adverse events (extrapyramidal symptoms, weight gain, sedation, sexual dysfunction and diabetes), compliance, relapse and treatment in hospital setting. Effectiveness was defined as the length of time without relapse over the evaluation period, and by Quality-Adjusted Life Years (QALYs). Parameter estimates were based upon published literature and clinical trial data. Resource utilization data were obtained from the 2009 National Health Insurance Reimbursement Data and costs were estimated from the social perspective. RESULTS: The time without relapse (over five-year) for patients receiving sertindole was similar to those with risperidone, olanzapine and quetiapine (1.9030 versus 1.9025, 1.9025 and 1.9028). Per patient costs over 5-year with sertindole was below that of olanzapine (KRW 10.5M versus 12.9M) but above the costs of risperidone and quetiapine (KRW 10.5M versus 8.4M and 8.9M). Based on the outcome of the model, the effectiveness of sertindole is almost equivalent to that of the other atypical antipsychotics. But medical costs (including in- and outpatient care) for sertindole are similar to or marginally higher than those of the other atypical antipsychotics. CONCLUSIONS: Though not cost-effective, but with equivalent clinical effectiveness, a good tolerability profile and acceptable costs, sertindole is an additional valuable treatment alternative to other atypical antipsychotics in South Korea.