A systematic review on the economic evaluation of physical activity interventions for type 2 diabetes control

Background: The economic evaluation of physical activity interventions has become an important area for policymaking considering the high costs attributable to physical inactivity. However, the evidence for such interventions targeting type 2 diabetes control remains scarce. Aim: The present study aimed to synthesize economic evaluation studies of physical activity interventions for type 2 diabetes control. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 statement (PROSPERO reference number CRD42021231021). An electronic search was performed in PubMed, Web of Science, Cochrane Library, and NHS Economic Evaluation Database. Studies were eligible if they included adults with type 2 diabetes, any physical activity intervention in community settings, an experimental or quasi-experimental design, and a parameter of economic evaluation (cost analysis of interventions, cost-effectiveness analysis [including cost-utility analysis] and cost-benefit analysis) as an outcome. Two independent authors screened the potentially eligible studies, and both assessed the methodological quality of included studies using the Consolidated Health Economic Evaluation Reporting Standards statement. Results: Ten studies were included in this review: seven were randomized controlled trials and three were quasi-experimental studies. All studies included direct costs, and four also included indirect costs. Four studies demonstrated that physical activity interventions were cost-saving, six studies showed cost-effectiveness, and two studies reported cost-utility. The estimates varied considerably across the studies with different analytical and methodological approaches. Conclusion: Overall, this systematic review found that physical activity interventions are a worth investment for type 2 diabetes control. However, comparability across interventions was limited due to heterogeneity in interventions’ type, design and delivery, which may explain the differences in the economic measures.Protocol: PROSPERO [CRD42021231021]. Funding: Portuguese Foundation for Science and Technology [UIDB/04750/2020; LA/P/0064/2020; SFRH/BD/136702/2018]