OBJECTIVES: Peripheral arterial disease (PAD) is a high prevalence disease after 50 years old, with considerable impact in quality of life, productivity, disability and longevity. Screening program for high risk populations followed by risk factors modification seems to be a cost effective strategy, but adherence to treatment is crucial to achieve clinical and financial goals. The aim of this study was to evaluate the minimal adherence rate, to risk factors drugs modification to achieve the return of investment for screening-management programs in the Brazilian public health system context. METHODS: a decision tree – return of investment model was developed in Excel® to analyze the impact of implementing a screening-management program for early detection and risk management modifications in peripheral arterial disease. Effectiveness of drugs to control the risk factor and reduce the risk of major cardiovascular events and major leg events was extracted from literature. Direct costs included treatment cost, exams, physician visits and events (AMI and Stroke), indirect cost was calculated considering the loose of productivity. The system overload with screening program, including physician visits and exams were considered in the model. RESULTS: Our hypothetical population was 2.844.201 subjects from Rio de Janeiro city, with a prevalence of PAD after 55 years old of 10% (133.185) and the prevalence of intermittent claudication of 5%(66.592). The total cost of implementing the screening-risk management program for the entire population was R$8.576.758.52, the financial equilibrium was achieved with full adherence of 46,3% of subjects, with a reduction of R$4.201.429,36 with system efficiency improvement, R$4.395.630,65 with indirect costs reductions and R$738.565,00 with direct costs reductions. CONCLUSIONS: A screening-risk factor management program for improve the quality of assistance for PAD is feasible in the Brazilian public health system context and achieve its equilibrium with full adherence to risk factor management of 46,3% of subjects.