OBJECTIVES: To provide a comprehensive and coherent reference document of published cost data for diabetic complications in France, Germany, Italy and Spain for use in economic diabetes modeling.  METHODS: A search for published cost of diabetes complications data from a health care payer perspective was performed on government websites, in peer-reviewed journals and local cost experts. All costs were inflated to 2013 Euros (€). RESULTS: First year costs of myocardial infarction varied between €3,041 in France and €9,690 in Germany. Heart failure costs were similar across countries: €3,104 in France; €2,791 in Germany; €4,000 in Italy and €3,316 in Spain. Costs of non-fatal stroke were higher in Germany (€16,441) than in other countries (Spain €8,016; Italy €6,073; France €5,447). Everywhere, the cost of haemodialysis was higher than peritoneal dialysis €35,972 versus €21,255 in Spain, €21,552 versus €18,485 in Italy, €34,290 versus €34,069 in Germany €71,683 versus €48,752 in France. Renal transplant cost was estimated to €84,114 in France, €34,858 in Germany, €38,528 in Italy and €26,618 in Spain. The cost of a major hypoglycemia requiring medical care was €4,275 in Spain, €2,561 in Germany, €1,391 in Italy and €1,165 in France. Neuropathy complication costs varied widely: €3,808 (France); €16,762 (Germany); €4,290 (Italy); and €5,330 (Spain) for foot ulcers and €6,056 (Italy); €7,754 (Germany); €9,578 (France); and €12,118 (Spain) for lower-extremity amputation. CONCLUSIONS: This study provides a coherent set of costs for diabetes complications in four European countries. Due to the differences in health care system structure and in cost transparency, the cost estimation methodology varied among countries. One limitation of this study is that diagnostic related group (DRG) tariffs were used to estimate several costs, which may not accurately represent the burden of a specific complication nor take into account the full burden of follow-up after an acute event.