OBJECTIVES: To assess the cost-effectiveness of gadofosveset-enhanced MR Angiography (VV-MRA) compared with conventional extracellular contrast agents enhanced MRA (EC-MRA), and computed-tomography angiography (CTA) for the diagnosis and treatment of chronic PAOD patients in Korea.  METHODS: It is assumed that diagnostic test affects the treatment decision and the patient’s health outcome consequently. Decision analytic model based on the published clinical guidelines for the PAOD diagnosis and treatment was constructed. We adopted societal perspective and 1 year time horizon. The sensitivity and specificity of imaging diagnostic tests were extracted from published studies to estimate probabilities of diagnostic positive and positive predictability. The studies that used the conventional angiography or digital subtraction angiography as a gold standard were included. Costs broke down into imaging costs and treatment costs. They were collected from experts’ panel survey and National Health Insurance Claims database. All costs were expressed in 2007. Quality weights for health outcomes were extracted from published studies. Incremental cost-effectiveness ratio was calculated and sensitivity analysis for various uncertain parameters was conducted. RESULTS: For the base case analysis, incremental cost per QALY of VV-MRA was 24,591,939KRW/QALY (US426,078/QALY) compared with CTA, and EC-MRA was dominated. The results of sensitivity analysis showed that the costs of imaging and treatments, and the probabilities of the treatment options didn’t change the results. The result could be influenced by prevalence rate. CONCLUSIONS: VV-MRA technique was the cost-effective option compared with EC-MRA and CTA for diagnosis for patients with chronic peripheral arterial obstructive disease.