OBJECTIVES:  Regular glucose monitoring is critical for T2DM patients treated with insulin. A novel, minimally-invasive flash glucose monitor (FreeStyle Libre™ system, “FM”) continuously measures glucose levels from interstitial fluid. Data transfers to a handheld reader from a wearable arm sensor without requiring routine lancing and blood samples for self-monitoring of blood glucose (SMBG). The REPLACE study showed that compared to standard SMBG, using FM for T2DM patients receiving intensive insulin led to a reduction in time spent in hypoglycaemia and required fewer blood glucose tests. This study evaluated the cost-effectiveness of FM versus SMBG in eight European countries. METHODS: The IMS Core Diabetes Model was run over a 40-year lifetime horizon. Patient characteristics reflected the REPLACE trial population. Intervention effects included trial-based reductions in hypoglycaemic events (27.7% reduction in glucose <70 mg/dL) and a utility benefit (0.03; Matza 2015). Cost data from published sources were inflated to 2015 currency, along with the cash price of €59/sensor. Incremental cost effectiveness ratios (ICERs) were reported, with sensitivity analysis performed on key parameters. RESULTS:  Base case ICERs (cost/quality-adjusted life year (QALY)) were SEK317,038 (Sweden) €29,672 (Germany), €28,745 (Spain), €20,968 (Italy), €29,008 (France), €28,369 (Portugal), €21,105 (Netherlands). Costs/non-severe hypoglycaemic event averted were SEK1292, and €95-120 for other European countries. Across scenario analyses, assuming a 20% reduction in utility benefit had the largest impact on the base case ICERs, raising them to SEK389,541, and ranging from €25,826-36,611 across remaining countries. CONCLUSIONS:  Base case ICERs were under published thresholds; results remained robust in sensitivity analysis. Given improved hypoglycaemia outcomes and FM health utility benefit, FM may be considered cost effective for T2DM patients receiving intensive insulin across examined countries.