Original Investigation
Critical Care Medicine
Cost-Effectiveness of In-Bed Cycling and Routine Physiotherapy for Patients Receiving Mechanical Ventilation
Jean-Eric Tarride, Gord Blackhouse, Bram Rochwerg, et al
JAMA Netw Open 2025;8;(9):e2529399. doi:10.1001/jamanetworkopen.2025.29399
Question What is the cost-effectiveness of in-bed cycling plus usual physiotherapy compared with usual physiotherapy alone among adults receiving invasive mechanical ventilation?
Findings This economic evaluation including 360 randomized clinical trial participants found that the per-patient cost of acquiring and delivering early in-bed cycling accounted for 0.5% of the index hospitalization costs. There were no statistically significant differences in the per-patient 90-day costs and quality-adjusted life-years between the 2 groups.
Meaning These findings highlight the need for future economic studies based on the totality of the randomized clinical trial evidence of in-bed cycling for critically ill patients.
Abstract
Importance The cost-effectiveness of adding early in-bed cycling to usual physiotherapy among adults receiving mechanical ventilation in the intensive care unit (ICU) compared with usual physiotherapy alone is unknown.
Objective To evaluate the cost-effectiveness of in-bed cycling plus usual physiotherapy compared with usual therapy alone in the Critical Care Cycling to Improve Lower Extremity Strength (CYCLE) randomized clinical trial.
Design, Setting, and Participants This trial-based economic evaluation with a 90-day time horizon compared early cycling plus usual physiotherapy vs usual physiotherapy alone from a societal perspective. Adult ICU patients (aged ≥18 years) receiving mechanical ventilation were recruited from 16 ICUs in Canada, the US, and Australia. Enrollment occurred from November 1, 2016, to May 30, 2023, with the last follow-up on August 3, 2023.
Interventions Intervention group participants were offered 30 minutes per day of cycling in addition to usual physiotherapy on weekdays, starting within the first 4 days of mechanical ventilation. Cycling continued until the patient could march on the spot for 2 consecutive days, ICU discharge, or for 28 days, whichever occurred first. Usual care participants were offered individualized physiotherapy according to local practices and patient alertness.
Main Outcomes and Measures Differences in costs (in 2024 Canadian dollars [CA$]) and quality-adjusted life-years (QALYs) between the groups were calculated. In the absence of dominance (ie, 1 strategy is associated with higher costs and fewer QALYs), the results were reported in terms of incremental cost per QALY gained.
Results The CYCLE trial recruited 360 patients (mean [SD] age, 61.5 [15.6] years; 205 male [56.9%]). The estimated per-patient cost associated with providing early in-bed cycling (CA$321) represented 0.5% of the index hospitalization costs (CA$66 554). The per-patient differences in 90-day costs (CA$5841; 95% CI, −CA$7666 to CA$18 797) and QALYs (−0.0009; 95% CI, −0.0185 to 0.0182) between cycling plus usual physiotherapy vs usual physiotherapy alone were not statistically different from 0. The probability of cycling plus usual physiotherapy to be cost-effective was 0.19 at a willingness-to-pay threshold of $50 000 per QALY gained.
Conclusions and Relevance In this trial-based economic evaluation, the differences in costs and QALYs between adding early in-bed cycling to usual physiotherapy and usual physiotherapy alone for adults receiving mechanical ventilation were not significantly different from 0. These results highlight the need for additional cost-effectiveness studies considering the full body of evidence regarding in-bed cycling for critically ill patients.
