OBJECTIVES: Despite solid evidence, measures for prevention, treatment and other health practices that could reduce mortality, disability and costs are not being used routinely in Canada. An economic model was developed to formally assess the potential clinical and economic impact of implementing a comprehensive stroke program. METHODS: A discrete event simulation was designed to assess the implications of various stroke strategies defined in terms of the usage of organized stroke units and clot-busting therapies, access to rehabilitation, stroke awareness and prevention campaigns. Stroke incidence, modified by whatever prevention practices are analyzed, is applied to the Canadian population to create the simulated patients with stroke. Each patient's management is simulated according to his characteristics and the interventions available given the strategy under consideration. Over time, patients are exposed to risks of: death, new stroke, change in functional level, and transfer to another location of care. Each event is processed in terms of its clinical consequences, resource use and cost. Data were obtained from the Registry of the Canadian Stroke Network, the Canadian Heart Health Survey, Statistics Canada and the Institute for Clinical and Evaluative Sciences. RESULTS: Implementation of widespread prevention and awareness campaigns would result in ~127,000 fewer initial strokes over 20 years. Access to organized stroke care would prevent stroke-related death in 25,000 patients, serious disability in 71,000, and nursing home admission in 25,000. Despite the costs associated with such a program, the net savings in healthcare costs over a 20-year period would amount to Can$12 billion. CONCLUSION: Implementing proven stroke therapies and practices across Canada will result in significant improvements in both lives and healthcare costs. Analyses based on this model will support national and provincial stroke strategies appropriate to their needs and resources.