Major lower extremity amputation (LEA) is a morbid complication of diabetes and peripheral artery disease (PAD) associated with high healthcare costs, significant functional disability, and early mortality [1–4]. Non-traumatic LEA related to diabetes and PAD is a source of preventable morbidity that disproportionately affects persons of racial and ethnic minority groups and low socioeconomic status [5,6]. The current narrative review aims to summarize existing literature on healthcare cost and utilization associated with diabetic lower extremity disease and PAD, inequalities in care that contribute to excess costs, and outcomes disparities that lead to a disproportionate economic burden of LEA on systematically disadvantaged populations in the United States (US).

Existing literature on the healthcare expenditures associated with treating threatened limbs is limited and features highly variable methodology. It is additionally challenging to contextualize existing literature given the changing prevalence and medical complexity of persons with diabetes and PAD, and the differences in healthcare funding, access, and delivery methods between regions and countries. The current narrative review focuses on recent US data to limit the variability conferred by attempting to compare multiple currencies and national health systems; however, authors recognize that high costs and disparate outcomes are a global problem. Broadly, publications were considered for inclusion if they were published after 2010, used US healthcare and/or economic data, and reported costs (rather than charges).