OBJECTIVES: Severe hypoglycaemic events (SHEs) are most commonly defined as symptomatic, severe hypoglycaemia in which a patient needs either assistance from another individual or professional medical care. SHEs impose a substantial economic burden on healthcare systems. The aim of our analysis is to assess the total number and corresponding costs (both direct and indirect) of SHEs in either type 1 or 2 diabetes in five Central European countries in a unified approach in order to compare results and main drivers of differences. METHODS: SHEs were further divided into low (only help provided on-site by a non-medical professional), medium (emergency care or consultation by a physician or other medical professional) and high (admission to  hospital) resource consumption episodes. Data on unit costs and resource use for low, medium and high resource consumption SHEs were collected for each country based on published literature and expert opinions. The risks of SHEs were determined separately for individual groups of anti-diabetic drugs used in monotherapy or in a combined treatment. Subsequently the economic model was developed to combine epidemiological data and drug use patterns for Czech Republic, Croatia, Hungary, Poland and Slovenia, to estimate the number of SHEs and resulting indirect and direct costs from payer’s perspective in each of the participating countries. RESULTS: Low resource consumption SHEs were rarely associated with resources used that were covered by public payers. Medium resource consumption SHEs contributed most to total direct costs. Hospital admissions directly associated with SHEs although not common, present a considerable expense to the healthcare system. The total number and corresponding costs of SHEs were different for participating countries as a consequence of diverse unit medical costs and sulphonylureas use. CONCLUSIONS: Our preliminary estimates for Central European countries suggested substantial economic burden associated with SHE and large differences between the countries.