OBJECTIVES: The experience of TIA patients in the UK NHS can be quite disparate. Patients presenting to primary care are often referred to a weekly clinic, creating a delay in access to effective treatments for this condition. The recent EXPRESS study by Rothwell et al. (Rothwell, Peter M., et al. Lancet. Online 9 Oct 2007 DOI:10.1016/S0140-6736(07)61448-2) clearly demonstrated that a greater focus on effectively managing TIA could have a significant impact on subsequent stroke rates. We wanted to examine how the implementation of the care pathway outlined in Phase 2 of the EXPRESS study could affect rates of stroke, and to explore the financial implications of such a shift in care. METHODS: We developed an economic model to estimate the costs and savings associated with setting up a rapid assessment and treatment clinic for patients with suspected TIA, in line with Phase 2 of the EXPRESS study. We used a local population of 500,000 people with an assumed annual incidence of TIA of 0.19%. Current management was based on national clinical guidelines and common clinical practice. We included all direct costs associated with care (medications, diagnostics and staff), and modeled the impact of changing management over a three-year time horizon, in line with NHS planning timeframes. RESULTS: For an assumed population of 500,000, changing the pathway of care for TIA management resulted in 295 future stroke events avoided over three years. As a result, the additional costs associated with changing the pathway of care for TIA were greatly outweighed by the savings generated through avoiding acute management costs associated with stroke. CONCLUSIONS: The model suggests that the implementation of the changes outlined in phase 2 of the EXPRESS study is cost saving for a local population of 500,000 with an assumed TIA rate of 0.19%.