OBJECTIVES::  Schizophrenia(SCZ) is a chronic severe and disabling mental disorder. The highest direct and indirect costs to patient/caregivers, payers and societies come from relapses usually associated with low treatment adherence. Albeit real-world and clinical trials data showed that long acting injectable antipsychotics(LAI) were associated with lower relapse rate than oral antipsychotics, in Brazil these drugs are not reimbursed regularly either in the Private health care system or Public(SUS). Thus, some patients have to pay drug and hospitalization costs out of pocket due to little or no insurance coverage. The present study aims to investigate the health and economic impact of LAI on SCZ patients in Brazil. METHODS::  A health economic model was developed to compare the health and cost outcomes of patients treated with commonly prescribed antipsychotics in Brazil as maintenance therapy from the patient perspective to put it in context of self-pay economics. The comparators included paliperidone palmitate 1-month dosing(PP1M) LAI, along with commonly used oral treatments. The model tracked treatment persistence, relapse, key adverse events and direct(e.g.hospitalization) and indirect costs(associated with unemployment, care giving, loss in productivity and mortality). Clinical inputs were based on mixed treatment comparisons of pivotal phase III clinical-trials, while cost inputs were based on Brazilian drug and health service databases. RESULTS::  Over a 1-year period, SCZ patients without treatment on average had 0.57 relapses and incur R$55,572 total costs(direct and indirect). Patients on PP1M experienced fewer relapses(0.24) than those on oral(0.29~0.43) or no treatment. The reduction in relapse was due to improved treatment persistence and better efficacy. Receiving either PP1M(R$38.650) or oral treatments(R$39.032~R$47.658) reduced total costs compared to no treatment, with cost being the lowest for PP1M. CONCLUSIONS::  SCZ imposes significant health and cost burden on patients and their families. PP1M provided a better alternative to orals in reducing relapses and total costs, including hospitalization.