Introduction: Telestroke system allows the sharing of medical information and the remote administration of fibrinolysis to a person who has suffered a stroke, regardless of their location. The objective of the present study is to provide a tool to model different care scenarios of a stroke patient and to measure results in terms of efficiency and cost. Materials and methods: We established a decision tree-based analytical model representing five scenarios. The baseline scenario represented the current management of patients in eight accident and emergency departments, two primary stroke units (PSUs) and a comprehensive stroke unit (SU), all connected via a telemedicine tool. Four variants of this first scenario were proposed, based or not on telemedicine. Efficiency criteria were thrombolysis rate; rate of return home; and quality-adjusted life-years. Costs were based on actual patient resources used. Results: Once the model parameters were identified, the results were used to compare the scenarios in terms of cost and efficiency. The different assumptions, transition probabilities, data sources, and efficiency and modelling costs are discussed. Discussion: This model provides a medico-economic evaluation of the Telestroke system. It is an adjustable and scalable model that can be applied in other regions and adapted to other medical fields. Conclusion: telemedicine appears to be a cost-effective modality for the management of stroke. The modelling makes it possible to take into account the regional specificities and the organization of the sector within the territory.