BACKGROUND: Serum total and LDL cholesterol levels are high (13.9% for borderline high LDL- cholesterol) and increasing in China. Hyperlipidemia is a main risk factor for cardiovascular and cerebrovascular diseases. Screening is one of the effective prevention methods; however, there has been no appraisal of the cost-effectiveness of blood lipid screening in China. OBJECTIVES: The aim of this study was to determine the cost-utility of blood lipid screening and subsequent interventions versus no screening for the prevention and treatment of hyperlipidemia and its complication. METHODS: Cost utility analysis based on a Markov model was conducted for a cohort of Chinese adults aged 45 and abovefrom screening to death. Published clinical trials and epidemiological studies retrieved from electronic bibliographic databases; supplementary data obtained from CVD patients survey in China. Markov model simulated the long term effects of screening and no screening strategies from the aspects of cost and effectiveness. The model assumed a 30 year time horizon, and costs and benefits were discounted at 5%. The willingness-to-pay threshold is ¥100,000/QALY.   Sensitivity analyses were conducted to evaluate assumptions of the model and to identify which model inputs had most impact on the results.  RESULTS: Estimated costs for each quality adjusted life year (QALY) gained among no screening population were ¥6325.8, with cumulative costs of ¥77112 and cumulative utility of 12.19, and ¥5783.5 for screened population with cumulative costs of ¥72178 and cumulative utility of 12.48, respectively. The results showed the blood lipid screening was associated with increased QALY and potentially cost-saving as compared with no screening. Sensitivity analyses demonstrated robustness of the results. CONCLUSIONS: Based on this Markov model, blood lipid screening is likely to be cost-effective option compared with no screening for the prevention and treatment of hyperlipidemia and its complication among Chinese aged 45 and above.