OBJECTIVE: The purpose of this study was to derive the cost-of-care for ischemic stroke by functional status and create a decision analytic model to compare the cost-effectiveness of citicoline to standard therapy. METHODS: Expert data were gathered on the average level of resource consumption by time period (acute hospital, recovery, and maintenance) and functional status (by Barthel Index score). Resource data was gathered from 10 experts in ischemic stroke care using a modified Delphi panel technique. Costs were derived from national claims databases and the literature. Included in the model were direct medical costs associated with hospitalization, rehabilitation, home care and medications. Effectiveness was based on the utility values of the Barthel outcomes. Clinical outcomes of treatment with citicoline and standard care, which included the use of tPA in 3.6% of the cases, were taken from the literature. Cost of care and cost-effectiveness was derived using a simple linear model. RESULTS: The cost of care for ischemic stroke patients during the maintenance period (3-12 months) was $4,274 for patients with a Barthel Index score at 3 months between 95-100, $15,981 for patients with a score between 55-90, and $35,533 for patients with a score between 0-50. It was estimated that the expected direct medical cost per citicoline treated ischemic stroke patient for one year is $37,066 compared with $38,456 for standard care. The expected utility for a patient treated with citicoline was 0.547 utilities and for standard care it was 0.479 utilities. CONCLUSION: A change in function following ischemic stroke drives important cost differences. The use of citicoline in the treatment of ischemic stroke compared to standard care both improves outcomes and reduces cost.