Sudden cardiac death of a high school athlete is an alarming tragedy. Three preparticipation screening methods have been recommended to reduce its occurrence: specific cardiovascular history and physical examination, 12-lead ECG, and two-dimensional (2D) echocardiography. This study analyzes the cost effectiveness of each of these methods. The cost to perform each test and to evaluate abnormal screening findings were approximated. The years of life gained through detection of athletes with potential causes of sudden cardiac death were estimated. Overall, the approximate costs per year of life saved for the preparticipation cardiovascular screening examinations are: specific cardiovascular history and physical examination, $84,000; 12-lead ECG, $44,000; and 2D echocardiography, $200,000. The 12-lead ECG is the most cost effective preparticipation cardiovascular modality of the three currently recommended methods. Similar cost effectiveness for history and physical examination or 2D echocardiography would require respectively a 2-fold increase in sensitivity or 4.5-fold decrease in cost.