Aim: Stroke is the commonest neurologic ward admission diagnosis in Ethiopia. It createsrnsignificant economic burden on the health care system. The acute stroke care cost is a majorrncomponent of the annual cost for stroke. In this study, we aimed to determine the total acuternstroke care cost per patient admitted to a tertiary level government hospital in Addis Ababa,rnEthiopia. And to identify components and predictors of the costs in order to better estimate thernoverall cost of stroke. rnMaterials and methods: This prospective study was done in Tikur Anbesa specialized hospital andrnYekatit-12 hospital medical college on ward admitted patients between December 2020 andrnOctober 2021. All ward and ICU admitted stroke patients during the study period were enrolled.rnDirect and indirect costs from first stroke attack up to discharge were obtained. We used multiplernlinear regression analysis to determine factors associated with hospital cost. rnResults: A total of 118 stroke patients admitted to the study hospitals were enrolled and finalrnanalysis was performed on 99 patients. The mean acute stroke care cost per patient at the studyrnhospitals was 14616.5 birr (228.3USD), direct and indirect costs 10209.55 birr (214.4 USD) and 4514.rn6 birrs (94.8 USD) respectively. The average length of stay was 9.38 days. Multiple linearrnregression analysis of the natural log of the total acute stroke care cost showed variation in costsrnwere largely attributable to: the length of hospital stays, ICU admission and rural residence. rnConclusions: Acute stroke care cost in Addis Ababa, government tertiary hospitals are lower thanrnprevious African studies. Direct medical cost contributes the majority of acute stroke care cost.rnLength of hospital stay and ICU admission were the cost driving factors.