OBJECTIVES: This study aims to evaluate the current management and associated costs of acute ischemic stroke (AIS) for patients admitted in stroke units in France and over a 1 year follow-up period as well as to assess the impact of improved thrombolytic management in terms of increasing the proportion of patients receiving thrombolysis and/or treated within 3hrs from symptom onset on functional recovery and care pathways. METHODS: A decision model was developed, comprising two components: the first corresponding to the acute hospital management phase of patients with AIS up until hospital discharge and the second corresponding to the post-acute phase. Patient journeys and costs were determined for both phases. Improved thrombolytic management was modeled by increasing the proportion of patients receiving thrombolysis from the current estimated level of 16.7 to 25% as well as subsequently increasing the proportion of patients treated within 3 hours of the onset of symptoms post-stroke from 50 to 100%. The impact on care pathways was derived from clinical data. RESULTS: In 2011, 29,999 stays took place in a stroke unit for AIS in France. 60% of discharges were to home, 25% to rehabilitative care then home, 2% to rehabilitative care then a nursing home, 7% to long-term care and 6% of stays ended with a patient death. Of a total cost over 1 year of €610 million (mean cost per patient of €20,326), 70% concern the post-acute phase. By increasing the proportion of patients thrombolyzed, costs are reduced primarily by a decrease in rehabilitative care, with savings per additional treated patient of €1,462. By adding improved timing, savings are more than doubled (€3,183 per additional patient). CONCLUSIONS: By improving thrombolytic management in stroke units, patient journeys through care pathways can be modified, with increased discharges home, a change in post-acute resource consumption and net savings.