The aim of this study was to evaluate the screening procedures in Japan economically focusing on the screening costs and the hospital costs for abdominal aortic aneurysm (AAA) surgery. A total of 10 057 residents, 60 years of age or older, including 4 247 men and 5 810 women, participated in the screening test for AAA using ultrasound. Aneurysms were detected in 34 participants, including 32 men and 2 women. The detection rate of AAA was 0.8% in men, 0.03% in women, and 0.3% in total. It cost US$8 to screen each participant, and the cost to detect each aneurysm was thus estimated at $1 250 in men, $23 240 in women, and $2 366 in total. The difference in the mean hospital cost between ruptured and nonruptured AAA was $21 833 in our recent cases. Obesity, male sex, and smoking habits were all significant risk factors for AAA. Screening for AAA using ultrasound is useful not only for the early detection of AAA but also for a reduction in the overall medical cost.