OBJECTIVES: To assess the healthcare costs and resource utilization of elderly patients with high risk vascular disease (HRVD) METHODS: A retrospective cohort study was conducted using the Truven MarketScan Medicare claims database to identify patients >=65 years, who had HRVD (defined as cerebrovascular disease [CVD], coronary artery disease with diabetes [CADD], peripheral artery disease [PAD], or history of acute coronary syndrome [ACS] [>=30days through 365 days after discharge for ACS]) between 10/01/2008 and 09/30/2009, with minimum 12-month pre-index and 24-month post-index insurance eligibility. Annual healthcare costs and resource utilization were compared across HRVD patients with 1, 2, or 3 affected arterial beds for the first- and second-year follow-up periods. The comparison of mean costs between cohorts was conducted using a generalized linear model with log link function and gamma distribution. RESULTS: The cohort included 203,949 patients with a mean age of 77.0 years; 52.8% were male. Among the identified HRVD patients during the first/second year, 7.3%/6.3% had ≥ 1 hospitalization event and 27.0%/23.2% had ≥ 1 ER visit. The mean annual number of physician office visits was 26/20 for the first and second year respectively. Mean total annual healthcare costs per HRVD patient for the first and second year were $17,899/$17,552, of which outpatient costs were $8,911/$6,861, inpatient costs were $5,296/$6,167, and pharmacy costs were $3,692/$4,525. HRVD-related costs during the first ($7,528) and second year ($7,565) accounted for more than 40% of the overall total healthcare costs. Mean total annual costs in the first and second year were $16,794/$16,631, $22,116/$21,096, and $26,575/$24,556 for patients with 1, 2, and 3 affected arterial beds (P<0.001).  CONCLUSIONS: These results show the high economic burden of HRVD and the especially high economic burden associated with elderly HRVD patients with multiple affected arterial beds.