OBJECTIVES: The aim of this study was to evaluate the predicted clinical and economic advantages stroke units specifically dedicated to the care of patients after a stroke compared with conventional care. METHODS: The course taken by patients through the French healthcare system after acute hospitalization for stroke was identified from an observational survey carried out by the stroke registry, Dijon. This data was used to construct consumption profiles according to the degree of autonomy and the organization of care for patients. The relative risks of death or institutionalization, or death or dependence after passage through a stroke unit were analyzed in comparison with conventional hospital services from the data available in meta-analyses. These risks were inserted in a Markov model. RESULTS: In a previous study carried out in 12 centres on 435 stroke patients,: after an ischaemic or hemorrhagic stroke the mean cost per patient cared for conventionally for 18 months was estimated to be 19,513€. The modeling with the same follow-up period confirms this figure, with less than 5% error (18,757€ vs 19 513€). After 5 years, the cumulative expenditure for the care of 120,000 patients in conventional care units was 3.710 millions €. Where care is generalized in a stroke unit, this figure increases to 4.160 million €. Comparison of the additional cost and added efficacy gave a ratio of 1359€ per year of life gained without disability (Barthel 95-100). Even if the cost of running the stroke units was 10-times higher than the current rate for conventional care, this ratio would not be higher than 15 646€. CONCLUSION: The cost-effectiveness ratio between for stroke units is much lower than the threshold for cost-effectiveness considered acceptable by the international scientific community (53,400 €). This extremely favorable ratio could justify organizational changes and the establishment of stroke units in the hospital environment.