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A prespecified economic evaluation published in the Journal of Clinical Oncology by Chan and colleagues assessed the cost-effectiveness of the structured exercise program tested in the phase III CHALLENGE trial, conducted by the Canadian Cancer Trials Group. The parent trial randomly assigned 889 patients with stage III or high-risk stage II colon cancer, following surgery and adjuvant chemotherapy, to a three-year supervised exercise program or to health education materials alone, and reported longer disease-free and overall survival in the exercise group.
The analysis took the Canadian public payer perspective over a five-year horizon, using participant-level cost, survival, and quality-of-life data collected during the trial, with a 1.5 percent discount rate and figures expressed in 2024 Canadian dollars. Quality-of-life responses on the SF-36 were mapped to health utility values using a validated algorithm.
Delivering the program cost $2,917 per participant, including the fixed cost of training the exercise staff, roughly 9 percent of total spending in that arm. Total costs came to $31,957 per participant in the exercise group against $33,546 in the education group, a difference of $1,589. The exercise group also gained 0.05 life-years and 0.10 quality-adjusted life-years, making the strategy dominant, meaning less expensive and more effective. Bootstrapping placed the intervention in the dominant quadrant in 53 percent of samples, with an 80 percent probability of falling below a willingness-to-pay threshold of $50,000 per quality-adjusted life-year and 84 percent below $100,000.
Savings traced to reduced downstream care. Cancer recurrence and new malignancy accounted for $12,732 per participant in the exercise group versus $15,772 in the comparator, and anticancer therapy $12,660 versus $14,582. A threshold analysis found the delivery cost could triple to $9,006 per participant before exceeding the $50,000 threshold.
The authors set these figures against 26 cancer medicines recommended for reimbursement by Canada's Drug Agency in 2025, of which four fell below $50,000 per quality-adjusted life-year, with a median of $242,571. They note that budget silos may block savings generated through reduced drug utilization from being redirected to fund exercise staff, and conclude that clinicians, policy-makers, and payers should proceed with implementation.
