OBJECTIVES: Two human papillomavirus (HPV) cervical cancer (CC) vaccines are currently available: a bivalent HPV-16/18 vaccine and a quadrivalent HPV-6/11/16/18 vaccine. The quadrivalent vaccine has an additional effect against genital warts, while the other offers broader protection against oncogenic non-vaccine types (cross-protection). The annual cost-consequences of both vaccines on HPV-related morbidity (i.e. abnormal pap smears, CIN1, CIN2/3 lesions, CC and genital warts) were evaluated within three European countries: Italy, UK and the Netherlands. METHODS: A static population model was developed in Excel®. The two vaccines differ in cross-protection level based on the latest results from clinical trials using, for both, the HPV naïve population (without current or past HPV infection) and country specific HPV-type distribution in each related lesion. Costing was performed from a health care perspective and obtained from published sources and official tariff data. No discounting was applied as results are reported over one year after reaching steady state. RESULTS: The more cross protection observed with the bivalent vaccine leads to an additional reduction in 9 510, 22 189, and 781 abnormal pap smears respectively in Italy, UK and the Netherlands; 275, 22,951, and 184 CIN1; 1,479, 8,693, and 833 CIN2/3; and 345, 142, and 28 CC cases while the quadrivalent vaccine results in 23,260, 50,324, and 2,983 genital wart cases prevented per year. More cost was saved with the bivalent compared with the quadrivalent vaccine and the amount per country per year was estimated at €2,719,040, £22,044,085, and €1,951,369 respectively. CONCLUSIONS: Within the Italian, the UK and the Netherlands settings the additional level of cross protection of the bivalent vaccine allows for more reduction in CC and HPV-related morbidity resulting in more cost savings that completely offset the benefit the quadrivalent vaccine has in preventing genital warts.