OBJECTIVES: To identify and evaluate resource utilization and related costs of SCI patients after initial rehabilitation. Both direct (devices, modifications of home or workplace) and indirect (lost productivity) costs were included and evaluated. METHODS: This was a monocenter, retrospective chart-review study supplemented with phone interviews to collect information on home and workplace modifications. The last 200 consecutive patients from the Berufsgenossenschaftliche Unfallklinik Hamburg, Germany fulfilling in- and exclusion criteria (most importantly: age 18-35, SCI at C6 or below). Endpoints: Ability to work, actual working patterns, need and costs of home and workplace modifications, need, and costs of professional help for ADLs, costs of mobility devices. A societal perspective was adopted. RESULTS: Total cost from an societal perspective per person in this study was €32,517 (19% devices, 10% professional help, 22% home modifications, 49% indirect costs) in the first year and is estimated at €19,186 for the following years. This does not include cost for workplace modifications for which no reliable data could be collected. However, it may be reasonable to assume this cost to be in the same order of magnitude as the costs for home modifications. Average yearly transfer payments (rent and social welfare) were estimated at €7301 for each patient. CONCLUSIONS: Indirect costs are the major cost driver for SCI-patients, in particular after the first year when initial payments for devices and home modifications are done. Investments to increase the share of working persons with SCI (e.g. by improving mobility and accessibility) are likely to be highly profitable from a societal point of view.