OBJECTIVE: To estimate the cost-effectiveness of citicoline in comparison to conventional therapy for the treatment of patients with acute ischemic stroke. METHODS: Decision tree analysis incorporating economic data and results from alternative systematic reviews of effectiveness. Data on effectiveness were obtained from a systematic review performed by the Cochrane Stroke Review Group (CSRG) and a pooled analysis of primary data from clinical trials sponsored by the Ferrer Group. Resource use was obtained from a panel of experts based in 5 Spanish hospitals. Unit costs were obtained from the centres included in the study and from prices published by the Spanish health care authorities. Two alternative scenarios were considered: hospitalised patient and hospitalised patient with ambulatory follow-up. Sensitivity analysis of the key variables included was performed. The time horizon for the study was 12 weeks. RESULTS: Even in the most unfavourable scenario analysed, citicoline proved to be an efficient treatment option in patients with acute ischemic stroke. Citicoline led to increases in the proportion of patients without discapacity of between 5% and 10%, compared to conventional treatment. Based on the efficacy figures reported by the CSRG, the cost per patient treated with citicoline was €3026.12 when only hospitalisation was taken into account, while the equivalent cost per patient receiving placebo was €3127.34. When the costs of ambulatory follow-up were added, the cost per patient increased to €3663.50 in the citicoline group and €3795.90 in patients receiving placebo. CONCLUSION: Citicoline is an effective and efficient treatment alternative in the management of stroke patients, in all of the scenarios analysed.