The economic assessment of animal diseases is essential for decision-making, including the allocation of resources for disease control. However, that assessment is usually hampered by the lack of reliable data on disease incidence, or treatment and control measures, and that is particularly true for swine production diseases, such as infections caused by Streptococcus suis. Therefore, we deployed a questionnaire survey of clinical swine veterinarians to obtain the input data needed for a stochastic model to calculate the costs caused by S. suis, which was implemented in three of the main swine producing countries in Europe: Germany, the Netherlands and Spain. S. suis-associated disease is endemic in those countries in all production phases, though nursery was the phase most severely impacted. In affected nursery units, between 3.3 and 4.0% of pigs had S. suis-associated disease and the mortalities ranged from 0.5 to 0.9%. In Germany, the average cost of S. suis per pig (summed across all production phases) was 1.30 euros (90% CI: 0.53–2.28), in the Netherlands 0.96 euros (90% CI: 0.27–1.54), and in Spain 0.60 euros (90% CI: 0.29–0.96). In Germany, that cost was essentially influenced by the expenditure in early metaphylaxis in nursery and in autogenous vaccines in sows and nursery pigs; in the Netherlands, by expenditure on autogenous vaccines in sows and nursery pigs; and in Spain, by the expenditures in early metaphylaxis and to a lesser extent by the mortality in nursery pigs. Therefore, the differences in costs between countries can be explained to a great extent by the measures to control S. suis implemented in each country. In Spain and in Germany, use of antimicrobials, predominantly beta-lactams, is still crucial for the control of the disease.