OBJECTIVES: To investigate the resource use and cost of rotavirus gastroenteritis (RVGE) in children aged <5 years presenting to primary care in four European countries, Italy, Spain, the Czech Republic and Poland.  METHODS: This observational, prospective study collected data from children aged <5 years presenting to primary care (general practitioners and paediatricians) with acute gastroenteritis (defined as diarrhoea for <14 days) and a positive test for rotavirus.  Severity of RVGE was assessed using the Vesikari score.  Parents completed a cost questionnaire at a follow-up visit or phone call 14 days after the episode, recording information on: direct medical costs (physician visits and contacts including the initial visit, use of medication, rehydration solutions and nutritional products); direct non-medical costs (transport, supervision/carer costs, other costs); and indirect costs (days lost at work or school/daycare).  All costs were recorded in 2006 Euros.  RESULTS: Cost data were available for 502 children, of whom 126 were in Italy, 217 in Spain, 87 in Poland and 72 in the Czech Republic.  A total of 65% of the children (n=326) were aged 0–24 months, 52% (n=263) were male, and 82% (n=410) were rated as moderate/severe using the Vesikari score.  The mean total societal cost per child was €170.6 in Italy, €169.7 in Spain, €44.0 in Poland and €37.6 in the Czech Republic.  The share of the total societal cost borne by the family was highest in Italy (57.5%), compared with 55.0% in Poland, 48.3% in Spain and 35.9% in the Czech Republic.  CONCLUSIONS: Paediatric RVGE presenting to primary care is associated with substantial direct and indirect costs, a high proportion of which are borne by families.  These data will be valuable in economic evaluations of paediatric rotavirus vaccination. Acknowledgements to  the SPRIK investigators, VIVA Spanish investigators, José Baldó, Nadia Meyer and Montse Soriano-Gabarró