OBJECTIVE: It is well recognized that major atherothrombotic events are associated with substantial resource use, translating to significant economic burden. The impact of peripheral arterial disease (PAD) is less clear. In this study, we described the resource use associated with a diagnosis of PAD relative to stroke and myocardial infarction (MI). METHODS: Hospitalization records were examined for 16,440 patients diagnosed with PAD in Saskatchewan, Canada between 1985-1995, and compared to records for patients suffering a stroke (18,704) or MI (15,590) between 1990-1995; all followed to December 2000. Hospitalization rates for any cause, cardiovascular disease (CVD) and bleeding events in the five years following diagnosis were estimated and compared across diagnoses. RESULTS: Approximately half of PAD (45%) and stroke (52%) patients and 36% of MI patients are female. Mean age ranged from 67-70 years of age across groups. Overall, between 73% and 86% of patients were hospitalized at least once, with the PAD group experiencing the greatest frequency (mean=5.2, sd=5.0) compared to MI (4.8, 4.5) and stroke (3.9, 3.9). In year one, rates of all-cause hospitalization were 0.86, 1.08, and 0.85 per patient year (PY) for PAD, MI, and stroke, respectively; for CVD hospitalization they were: 0.17, 0.35, and 0.21 per PY. In year two, the rate of all-cause hospitalization was highest for PAD patients (0.62 vs. 0.58 per PY for stroke and MI) and remained above or equal to that for MI and stroke in years three, four, and five. Similar patterns were observed for CVD hospitalizations, while rates for bleed-related hospitalizations were essentially equivalent. CONCLUSIONS: A diagnosis of PAD is associated with substantial resource utilization comparable to that observed among patients suffering a major atherothrombotic event. The economic implications of a PAD diagnosis ought to be taken as seriously as that of MI and a stroke.