OBJECTIVES: To determine the cost-effectiveness of measuring glycated hemoglobin with A1CNow ® compared with standard exam (SE) for DM2 patients, from the Brazilian Private Healthcare System perspective. METHODS: The study was a cost-effectiveness analysis based on Markov modeling to estimate costs and consequences of treatments. Epidemiological and efficacy data derived from a critical appraisal of the scientific literature. Only direct medical costs were considered. If available, costs of clinical events (CE) were obtained from burden of disease studies. If not, Brazilian official guidelines were obtained to determine the resources used to treat the CE. Drugs, hospital daily admission rates, procedures and laboratory tests unit costs were obtained from Brazilian official databases. Costs and benefits were discounted at 5% yearly. Outcomes were expressed as CE avoided. Probability sensitivity analysis (PSA) was conducted to assess model robustness. Life time horizon was analyzed.  RESULTS: Through the systematic review of the literature the studies were selected to form the body of clinical data for the analyses. The systematic review showed that although the absence of studies directly evaluating the impact of A1CNow on cardiovascular events, their favorable influence on cardiovascular disease intermediate markers suggests that A1CNow may have clinically relevant effect in patients at risk. The analysis showed higher clinical benefits and lower costs for A1CNow. Considering 100 patients, 99.8 and 146.1 CE happen in A1CNow and SE arms, respectively. The average time-horizon cost per patient was R$25,444(€11,108) and R$29,278(€12,782) for A1CNow and SE, respectively, showing the dominance of A1CNow compared to SE. PSA demonstrated that in 95.3% of the simulations A1CNow was dominant (more effective with lower cost) compared to SE.  CONCLUSIONS: Our study demonstrated that A1CNow have clinically relevant effect in reducing CE being dominant for monitoring of glycated hemoglobin in DM2 patients.  PSA confirmed this determinist result.