OBJECTIVES: Worldwide, stroke is the third most common cause of death in developed countries with declining death rates. In Austria the incidence rate of stroke is 2.1 – 2.3 per thousand annually. Cerebrolysin prevents acute neuronal damage and accelerates recovery after stroke. The purpose of this analysis was to determine costs of stroke for Austria in general and to estimate the cost-effectiveness of Cerebrolysin in combination with alteplase compared to alteplase alone. The analysis should assess health economic advantages in the acute care due to a faster improvement in neurological impairment and for rehabilitation in early post-acute phase and quantify the correlated reduced resource use in the health care and social system. METHODS: A Markov-model was developed based on the mRS states 90 days after stroke to simulate consequences over a 10-year time-horizon. Consequences include recurrent stoke, deteriorated mRS, death due to recurrent stroke or other reasons.  Health benefits were measured in quality-adjusted life years (QALYs) and life years (LYs). Monte-Carlo-simulation accounted for uncertainty. Probabilities were derived from RCTs and open-label studies; direct costs (2014) were derived from published sources from the payer’s perspective. QALYs, life years and costs were projected over a 10 year time-horizon. Costs and outcomes were discounted according to the national guidelines RESULTS: Austrian costs associated with Cerebrolysin amount to € 61,468.67 and generate 3.77 QALYs and 6.70 LYs. Costs without Cerebrolysin amount to € 62,257.88, achieve 3.75 QALYs and 6.70 LYs. The treatment strategy with Cerebrolysin dominates the strategy without Cerebrolysin. Assessing the disaggregated costs it becomes apparent that costs savings are due to lower acute stroke costs (€-493.29) and nursing-home costs mainly after first stroke (€-250.88). CONCLUSIONS: From a health economic perspective, Cerebrolysin is a cost-effective therapy; it mainly reduces event costs due to early remobilization and, in addition, rehabilitation and nursing-home cost.