OBJECTIVES: Accurate information about resources use and costs of stroke is necessary for informed health planning activities. The aim of this study was to determine the patterns of health resources use among stroke patients and to estimate the total costs (direct medical and non medical and indirect production losses) of stroke in Spain for 2001. METHODS: The cost-of-illness method was used. Direct and indirect costs were estimated using prevalence costs. Indirect costs (productivity costs) were estimated using the approach of human capital theory from lost earning attributable to stroke related mortality and morbidity. Data on resource use were retrospectively collected from hospitals and questionnaires. The costs of stroke during the first, second and third year after stroke and the total costs of stroke were estimated. RESULTS: We gathered information from 350 patients. The average cost per stroke survivor during the first, second and third year, in Spain during 2001, were estimated to be €10,189, €7,662, and €5,614 respectively. The most important categories of cost during the first year were acute hospitalisation and rehabilitation. During the second and third year the most important categories of costs were drugs, rehabilitation and tests. Stroke cost €1,402.34 million to the Spanish health care system, representing 4% of the total public health care expenditure, €3197.55 million in informal care and €392.95 million for productivity loss. The total annual cost of all stroke related burden was €4992.84 million. CONCLUSIONS: Stroke is a leading public health problem in Spain in term of the economic burden of disease. Given the magnitude of these costs, investigation of the cost-effectiveness of different interventions for stroke should become a priority.