OBJECTIVES: Stakeholders in Europe remain keenly interested in obtaining information to help assess country-specific value of SMBG for patients with type-2 diabetes and treated with OADs. From national reimbursement system perspectives in France, Germany, and Spain, this study modeled the long-term (40-year) cost-effectiveness of SMBG at 1, 2, or 3x/day (vs. no SMBG) for this patient population. METHODS: SMBG input costs (strips, lancets, monitors, nurse training) were supplied by LifeScan in €2007 values and applied as appropriate for each country’s current reimbursement policy. Cohort characteristics and assumed HbA1c effects came from a U.S. Kaiser Permanente longitudinal analysis of new SMBG users. Country-specific complication costs obtained from published sources were inflated to €2007 values. Base-case outcomes were discounted at 3% per annum for France and Germany; 6% for Spain. Sensitivity analyses varied time horizon (5, 10, 20 years) and discount rates relevant to each country. Sensitivity analyses also included a -0.036 dis-utility for SMBG in year 1. RESULTS: Incremental cost-effectiveness ratios (ICERs) were largest in France, where monitors were included as reimbursed SMBG acquisition costs. ICERs for SMBG 1x, 2x, and 3x/day were €12,114, €6,282, and €7,958, respectively. ICERs for SMBG 1 or 2x/day were