OBJECTIVES: Asymptomatic Peripheral Arterial Disease (PAD) is associated with greater risk of acute cardiovascular events.  American heart association and American college of cardiology clinical practice guidelines recommend low dose aspirin to reduce the cardiovascular events and mortality in PAD patients. As asymptomatic PAD often remains undiagnosed, opportunities for secondary prevention are missed in primary care. Therefore, there is a clinical need of early detection of asymptomatic PAD and to initiate the appropriate preventive treatment. United States preventive services task force’s recommendation against screening is heavily criticized and expansion of the evidence base for PAD screening is recommended in 2011 in a focussed update of the guidelines. This study aims to determine the value of PAD screening using ankle brachial index test in high risk individuals using decision analytic modelling. METHODS: A Markov model was developed to evaluate the cost effectiveness of selective PAD screening in high risk individuals followed by preventive treatment compared to no screening and no preventive treatment. The analysis was conducted from the societal perspective using a lifetime time horizon. To address the parameter uncertainty, probabilistic sensitivity analysis was performed. RESULTS: Screening and preventive treatment of identified PAD patients with low dose aspirin  is a dominant strategy producing higher mean quality adjusted life years per patient for a lower lifetime cost. The cost effectiveness acceptability curves show that 100% simulations favour screening followed by preventive treatment at a willingness to pay threshold of 400 Euros. CONCLUSIONS: This decision analysis suggests that the targeted screening and secondary prevention of cardiovascular events in the identified patients, is a highly cost effective public health intervention. This study results may provide one of the building blocks of evidence expansion for advocating PAD screening and to promote its more widespread use to detect and treat PAD patients.