OBJECTIVES: This study focused on evaluation of cost-effectiveness in the treatment with palmitate pipotiazine (Piportil L 4) vs. oral forms of traditional neuroleptics in public psychiatric outpatient clinic in Moscow. METHODS: To 25 outpatients with ICD-10 defined diagnosis of schizophrenia was prescribed palmitate pipotiazine for a period of six months in the present “mirror” - image analysis. Our intention was that the study should interfere as little as possible with routine clinical practice. Clinical improvement, drug tolerability and social functioning of the patients were evaluated with the PANSS, CGI scale, EPRS scale and original checklist on social functioning and quality of life (Gurovich & Shmukler, 1998). Economic evaluation was performed including relevant data about the direct and indirect costs for all of the patients. RESULTS: The data obtained indicate some statistically significant (p?0.05) clinical improvement with the PANSS, CGI scale as well as reduced drug side effects with ESRS (p?0.05). The improvement of social functioning and quality of life was indicated. The treatment of palmitate pipotiazine ensures a reduction of relapses, improving quality of remission states and a facilitation of the social adaptation of the patients. So direct and indirect costs were reduced. The study demonstrates cost-effectiveness of the treatment with palmitate pipotiazine (especially for the patients at high risk for future relapse and rehospitalization.) cf oral forms of conventional antipsychotics. CONCLUSIONS: It was concluded that the constant and prolonged outpatient maintenance treatment with palmitate pipotiazine should be cost saving alternative for the management of outpatients with schizophrenia in «real world» practice.