OBJECTIVES: To estimate the economic impact of the use of alteplase versus best supportive care (BSC) in patients with acute ischemic stroke in Mexico. METHODS: A decision tree cost-effectiveness (CE) model assessed the treatment related cost for Alteplase and BSC related to two mayor disease branches: with or without intracranial hemorrhage. Terminal nodes in each arm included death, independent- or dependent survival. Published results of head to head clinical trials efficacy inputs populated the model. Treatment algorithm was obtained from the local governmental guide. Public institutional direct medical costs (2014 purchases and price tabulators) where retrieved to adopt the national health system perspective. Governmental databases and 2014 purchases provided the epidemiology inputs. A five year forecast estimated the budget impact of the use of alteplase versus BSC. RESULTS: