To supply stable and high-quality power according to the advancement of industrial growth, electric power companies have performed maintenance of power facilities using various methods. In the case of domestic power distribution facilities, there are limitations in performing diagnostic management on all facilities owing to the large number of facilities; therefore, old facilities are managed using the health index assessment method. The health index assessment comprises only facility operation data and external environmental data and is managed only for four types of distribution facilities including overhead/underground transformers and switchgears. In the case of high voltage overhead lines, there are a large number of wires such as transformers and switchgears connected to the lines, and the ripple effect of power outages is large. However, in Korea, there is no overhead line health index standard. In overseas cases, a health index for overhead lines was developed, but only the material characteristics and surrounding environment of the overhead lines were considered and economic feasibility was not considered. Therefore, in this paper, we developed a health index evaluation methodology for ultra-high voltage overhead lines that considers economic feasibility. In this paper, unlike the existing health index evaluation method that uses only operational data and external environmental data to determine facility performance evaluation and aging replacement standards, we developed an economic health index evaluation methodology that additionally considers failure probability and risk costs. Using the health index assessment methodology developed in this paper, it is possible to expect a reduction in facility operating costs and investment costs from the perspective of the electric power companies through the replacement of old extra-high voltage overhead cables. In addition, from the perspective of consumers, it is expected to increase power reliability and reduce the ripple effect of failure by preferentially replacing equipment with a high probability of failure.