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Background Apps for real-time continuous glucose monitoring (CGM) on smartphones and other devices linked to CGM systems have recently been developed, and such CGM apps are also coming into use in Japan. In comparison with conventional retrospective CGM, the use of CGM apps improves patients’ own blood glucose control, which is expected to help slow the progression of type 2 diabetes mellitus (DM) and prevent complications, but the effect of their introduction on medical costs remains unknown. Objective Our objective in this study was to perform an economic appraisal of CGM apps from the viewpoint of assessing public medical costs associated with type 2 DM, using the probability of developing type 2 DM–associated complications, and data on medical costs and utility value to carry out a medical cost simulation using a Markov model in order to ascertain the cost-effectiveness of the apps. Methods We developed a Markov model with the transition states of insulin therapy, nephrosis, dialysis, and cardiovascular disease, all of which have a major effect on medical costs, to identify changes in medical costs and utility values resulting from the introduction of a CGM app and calculated the incremental cost-effectiveness ratio (ICER). Results The ICER for CGM app use was US 33,039/quality-adjustedlifeyear(QALY).ConclusionsSensitivityanalysesshowedthat,withtheexceptionofconditionswherethetransitionprobabilityofinsulintherapy,utilityvalue,orincreasedmedicalcostsincreases,theICERfortheintroductionofCGMappswasbelowthethresholdofUS 43,478/QALY used by the Central Social Insurance Medical Council. Our results provide …