OBJECTIVES: A budget impact model was used to estimate the effect of introducing ziprasidone on acute bipolar mania drug-related costs in Spain. METHODS: The model is based on disease prevalence, incidence, drug use, adverse effects, drug acquisition cost and sales forecasting data specific to Spain. It takes the perspective of the Spanish National Pharmaceutical budget and has a time horizon of 3 years. Drugs considered in the study were lithium, valproate, olanzapine, risperidone, quetiapine, aripiprazole, haloperidol, lamotrigine, oxcarbazepine and topiromate. Market shares for ziprasidone for the upcoming three years were estimated at 9%, 14% and 17%. RESULTS: Target population in Spain is estimated at 500,000 patients and 15% of those receive a monoterapia drug treatment for acute bipolar mania. Nowadays, when considering drug costs, direct medical costs and adverse events treatment, average annual cost per treated patient in Spain is estimated at €4,006 and it is likely to be estimated at €4,039 after the introduction of ziprasidone. Sensibility analysis showed that at a constant market share of 24% for the forecasted three years, then the introduction of ziprasidone is not likely to have any economic impact on the Spanish National Pharmaceutical budget. CONCLUSIONS: This budget impact model shows that the introduction of ziprasidone is likely to have minimal impact on acute bipolar mania medication costs in Spain. Current drug costs due to acute bipolar mania were estimated at €908 millions for the next 3 years and at €916 millions after the introduction of ziprasidone.