OBJECTIVES: Analyze the differential in selected direct costs of a collaborative structured blood glucose testing intervention in non-insulin treated patients with type 2 diabetes mellitus (T2DM) when compared to enhanced usual care (active control group (ACG)). METHODS: Data was derived from the Structured Testing Program (STeP) - a 1 year, prospective, cluster-randomized, multicenter study that examined the utility of a collaborative intervention using structured self-monitoring of blood glucose (SMBG) in 483 poorly-controlled (HbA1c > 7.5%) T2DM subjects compared to the ACG. The structured testing group (STG) used the ACCU-CHEK® 360¢ª View 3-day profile tool that facilitates collection and interpretation of 7-point glucose profiles. From a US payer perspective, direct costs of diabetes medications, lab HbA1c tests, physician visits, and blood glucose testing strips associated with STG were compared with ACG using student t-test at a significance level of 5%. RESULTS: In the intent-to-treat population, STG showed a significantly greater HbA1c reduction over 12 months than the ACG (-1.2% vs. -0.9%; D-0.3%; p=0.04). During the study,  STG incurred +$180.95 mean PPPY (Pay per Patient Year) total cost for diabetes medications, but -$173.73 mean PPPY for SMBG test strips, -$5.20 mean PPPY for lab HbA1c tests, and -$2.15 mean PPPY for physician visits compared to ACG. There was no significant difference in direct costs between STG and ACG (p =0.9898). CONCLUSIONS: Use of a collaborative structured testing intervention improved HbA1c in STG without increasing direct cost. The increased STG medication cost was offset by a decreased use of blood glucose test strips. As previously reported, STG subjects performed significantly fewer tests/day than ACG subjects (mean = 0.9 vs. 1.2, p=0.0003) over the year. Structured testing, from a 1 year US payer perspective, is an effective and overall cost-neutral tool for management of non-insulin treated patients with type 2 diabetes.