A cost-utility analysis was undertaken of enteral tube feeding (ETF) in patients with cerebrovascular accident (CVA). Mortality during ETF was established in nursing homes (n7007) or at home (n2888). Quality of life was measured (EuroQol) on a sub-sample (n25). Quality adjusted life years (QALYs) over 3 years and the cost/QALY were calculated. The cost/QALY (1 pound=1.482 euros; 30/06/05) for patients receiving ETF at home was 12,817 pounds (10,351 pounds-16,826 pounds using 95% CI for quality of life) and insensitive to the frequency of home visits (50-150% of the average frequency; 11,851 pounds-13,782 pounds), outcome of patients reverting to full oral feeding (0-100% survival; 11,023 pounds-14,440 pounds), and computed outcome of a 'control' group not given ETF (0.125-0.25 year survival; 12,991 pound-14,006 pounds). The cost/QALY in nursing homes (10,304 pounds-68,064 pounds) varied depending on the state contribution to non-medical costs and is above and below the threshold (30,000 pounds/QALY). The data suggest the cost-effectiveness of ETF in patients with CVA receiving ETF at home or in nursing homes, where the non-medical costs are paid privately, compares favourably with other interventions. The cost-effectiveness of ETF in nursing homes when the state pays all non-medical costs compares unfavourably with other treatments, raising economic, clinical, and ethical concerns.