OBJECTIVE: Suicide by teenagers is an alarming problem that is on the rise. This study examines admissions resulting from a suicide attempt by an adolescent and estimates the resulting cost of hospital care. METHODS: Cases of adolescent, defined as age 10 through 19 years, suicide attempts were identified using ICD-9 diagnosis, and the corresponding E codes. Inpatient hospital costs were developed based on 1999 discharge data from four US states. Cost estimates include all accommodation, ancillary and physician services. National physician fee schedules were also used. Cost estimates are reported in 2002 US$. Charges were adjusted by means of a cost-to-charge ratio. RESULTS: Of the 4067 suicide attempts identified, 70% were female. The mean age for adolescents in this group was 16.5 years. A drug overdose was listed as the principal diagnosis in 66% of cases. Almost three-quarters of cases were admitted via the emergency room and 37% had a stay in a special care unit. The mean length of stay was 3.4 days (range: 1-143) and the mean cost per stay was $5,680 (range: $407-$385,132). The inpatient case fatality rate was less than 1%. Of those discharged alive, 26% were transferred to either a mental health or residential care facility, and 5.6% were readmitted within 12 months due to another attempt. The majority (80%) of those readmitted had one additional stay for another attempt (range: 1-3) and all survived these subsequent attempts. Managed care organizations were the largest single payer group, responsible for half of the cases. CONCLUSIONS: The overwhelming majority of cases treated in this setting survive the attempt. Suicide attempts by adolescents generate substantial costs. Costs related to acute hospital treatment of clinical conditions resulting from a suicide attempt are but one economic aspect of managing these patients, as many require post-discharge health care services.