International Journal of Technology Assessment in Health Care



Doug Coylea1, Kathryn Coylea2, Glen P. Kennya3, Normand G. Bouléa4, George A. Wellsa5, Michelle Fortiera6, Robert D. Reida7, Penny Phillipsa8 and Ronald J. Sigala9

a1 University of Ottawa; Ottawa Health Research Institute email:

a2 Applied Health Economic Research Unit

a3 University of Ottawa

a4 University of Ottawa; University of Alberta

a5 University of Ottawa; University of Ottawa Heart Institute

a6 University of Ottawa

a7 University of Ottawa Heart Institute

a8 Ottawa Health Research Institute

a9 University of Ottawa; University of Calgary


Background: A randomized controlled trial has shown that supervised, facility-based exercise training is effective in improving glycemic control in type 2 diabetes. However, these programs are associated with additional costs. This analysis assessed the cost-effectiveness of such programs.

Methods: Analysis used data from the Diabetes Aerobic and Resistance Exercise (DARE) clinical trial which compared three different exercise programs (resistance, aerobic or a combination of both) of 6 months duration with a control group (no exercise program). Clinical outcomes at 6 months were entered for individual patients into the UKPDS economic model for type 2 diabetes adapted for the Canadian context. From this, expected life-years, quality-adjusted life-years (QALYs) and costs were estimated for all patients within the trial.

Results: The combined exercise program was the most expensive ($40,050) followed by the aerobic program ($39,250), the resistance program ($38,300) and no program ($31,075). QALYs were highest for combined (8.94), followed by aerobic (8.77), resistance (8.73) and no program (8.70). The incremental cost per QALY gained for the combined exercise program was $4,792 compared with aerobic alone, $8,570 compared with resistance alone, and $37,872 compared with no program. The combined exercise program remained cost-effective for all scenarios considered within sensitivity analysis.

Conclusions: A program providing training in both resistance and aerobic exercise was the most cost-effective of the alternatives compared. Based on previous funding decisions, exercise training for individuals with diabetes can be considered an efficient use of resources.


  • Cost-effectiveness;
  • type 2 diabetes mellitus;
  • aerobic exercise;
  • resistance exercise


  Funding for this study was part of the funding of the DARE trial. The DARE trial was funded by the Canadian Institutes of Health Research, the Canadian Diabetes Association and the University of Ottawa Interfaculty Grants Program. Dr. Sigal is supported by a Health Senior Scholar award from the Alberta Heritage Foundation for Medical Research. D.C. designed the analysis. K.C., G.A.W., and R.J.S. contributed to the design of the analysis. D.C., K.C., P.P., and R.J.S. researched data. D.C. and K.C. conducted the analysis and wrote the manuscript. G.P.K., N.G.B., G.A.W., M.F., R.D.R., P.P., and R.J.S. contributed to the discussion and reviewed/edited the manuscript.