OBJECTIVES: Abdominal aortic aneurysm (AAA) is a chronic, progressive disease that often requires surgical repair.  The risk of rupture and death both increase with the size of the aneurysm.  Scanning patients to identify the presence of an aneurysm and monitoring its growth is an important diagnostic practice for managing these patients. The present study investigates whether the use of a portable hand held device is cost effective in a hypothetical population of 10,000 (e.g., 65 years of age) male subjects with a history of smoking who would otherwise not be screened for AAA. METHODS: The study performed cost utility analysis, developing a simulation model that compared the incremental cost per quality-adjusted life year gained for four alternative scenarios. Scenario I received no scanning and Scenarios II – IV differed on what size AAA was to be treated if detected.  Model input values were taken from the literature.  The screened scenarios differ in terms of the size at which aneurysms were treated surgically. RESULTS: The total expected costs were: $20.4 million, $33.2 million, $19.8 million, and $18.7 million for Scenarios I to IV respectively.  The total expected deaths were: 72, 39, 50, and 58 for Scenarios I to IV respectively.  The incremental cost effectiveness ratio for Scenario II vs. Scenario I was $64,160. Compared to Scenario I, Scenario III and IV were dominant.  CONCLUSIONS: Under all of the treatment arms, the use of the handheld scanning device was cost effective relative to the Scenario I cohort.  Treating patients with medium or large aneurysms (Scenario III) or just large aneurysms (Scenario IV), substantially enhances the cost effectiveness.  These results suggest that primary care physicians should consider this device as a cost effective method to identify and treat AAA patients among male patients who are elderly and have a history of smoking.