OBJECTIVES: This study sought to examine the direct medical costs of stroke based on the actual hospital charge data in the incidence based cohort. METHODS: We obtained the cost data for 884 stroke patients in 8 university hospitals. The cost data targeted for all adult patients (≥19 years) admitted for stroke during 2 month (between November 1 and December 31, 2006) and were assessed for 2 years. The target patients were primarily diagnosed as ‘Subarachnoid hemorrhage (I60)’, ‘Intracerebral hemorrhage (I61)’, ‘Other nontraumatic intracranial hemorrhage (I62)’, ‘Cerebral infarction (I63)’, and also categorized by history of stroke; ‘primary stroke (1st onset)’, ‘recurrent stroke’. RESULTS: According to diagnosis distribution, I60 was diagnosed in 125 patients (14%), I61 in 158 patients (18%), I62 in 25 patients (3%) and I63 in 576 patients (65%). During study period, 85 patients (10%) were died and 471 patients (53%) were assessed for more than 1 year. The annual average direct medical costs for stroke (I60~I63) were KRW 8,530,941 for the 1st year of onset, KRW 1,098,316 for the 2nd year of onset. This result indicated that the 1st year accounted for 89% of 2-year direct medical costs. Analysis by the diagnosis class also revealed that the 1st year direct medical costs for hemorrhagic stroke (I60~I62) were KRW 13,518,895, which were more than double of costs for cerebral infarction (I63), KRW 5,863,771. The 2nd year costs were similar; KRW 1,055,934 for hemorrhagic stroke and KRW 1,115,700 for cerebral infarction. When categorized by history of stroke, the 1st year costs for primary stroke (KRW 8,837,111) were higher than those for recurrent stroke (KRW 5,988,121). CONCLUSIONS: This study is significant in that it examined stroke costs including non-reimbursed costs based on the actual hospital charge data while previous studies depended on the insurance claim data in Korea.