The existing method of pipeline health monitoring, which requires an entire pipeline to be inspected periodically, is unproductive. A risk-based decision support system (DSS) that reduces the amount of time spent on inspection has been presented. The risk-based DSS uses the analytic hierarchy process (AHP), a multiple attribute decision-making technique, to identify the factors that influence failure on specific segments and analyzes their effects by determining probability of occurrence of these risk factors. The severity of failure is determined through consequence analysis. From this, the effect of a failure caused by each risk factor can be established in terms of cost and the cumulative effect of failure is determined through probability analysis. The model optimizes the cost of pipeline operations by reducing subjectivity in selecting a specific inspection method, identifying and prioritizing the right pipeline segment for inspection and maintenance, deriving budget allocation, providing guidance to deploy the right mix labor for inspection and maintenance, planning emergency preparation, and deriving logical insurance plan. The proposed methodology also helps derive inspection and maintenance policy for the entire pipeline system, suggest design, operational philosophy, and construction methodology for new pipelines.