Tarride Jean-Eric, Blackhouse Gord, Rochwerg Bram, Fox-Robichaud Alison E, Ball Ian M, Burns Karen E A, Seely Andrew J E, Muscedere John, Berney Susan, Pastva Amy M, D'Aragon Frédérick, Archambault Patrick M, Tsang Jennifer L, Verceles Avelino C, Serri Karim, Reeve Brenda K, English Shane W, Lamontagne Francois, Karachi Tim, Duan Erick H, Strong Geoff, Kelly Laurel, Reid Julie C, Rudkowski Jill C, O'Grady Heather K, Herridge Margaret S, Thabane Lehana, Heels-Ansdell Diane, Cook Deborah J, Kho Michelle E
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.
JAMA Netw Open. 2025 Sep 2;8(9):e2529399. doi: 10.1001/jamanetworkopen.2025.29399.
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.
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.
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.
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.
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 $50 000 per QALY gained.
In this trial-based economic evaluation, the differences in costs and QALYs between adding early in-bed cycling to usual physiotherapy and usual physiotherapy alone for adults receiving mechanical ventilation were not significantly different from 0. These results highlight the need for additional cost-effectiveness studies considering the full body of evidence regarding in-bed cycling for critically ill patients.
在重症监护病房（ICU）接受机械通气的成年人中，与单纯常规物理治疗相比，在常规物理治疗基础上增加早期床上骑行的成本效益尚不清楚。
在重症监护骑行改善下肢力量（CYCLE）随机临床试验中，评估与单纯常规治疗相比，床上骑行加常规物理治疗的成本效益。
设计、设置和参与者：这项基于试验的经济评估以90天为时间范围，从社会角度比较早期骑行加常规物理治疗与单纯常规物理治疗。从加拿大、美国和澳大利亚的16个ICU招募接受机械通气的成年ICU患者（年龄≥18岁）。招募时间为2016年11月1日至2023年5月30日，最后一次随访于2023年8月3日进行。
干预组参与者在机械通气的前4天内开始，除工作日的常规物理治疗外，每天还进行30分钟的骑行。骑行持续到患者能够连续两天原地踏步、从ICU出院或持续28天，以先发生者为准。常规护理参与者根据当地做法和患者的清醒程度接受个性化物理治疗。
计算两组之间的成本差异（以2024年加拿大元[CA$]计）和质量调整生命年（QALYs）。在不存在优势的情况下（即一种策略与更高成本和更少QALYs相关），结果以每获得一个QALY的增量成本来报告。
CYCLE试验招募了360名患者（平均[标准差]年龄，61.5[15.6]岁；205名男性[56.9%]）。提供早期床上骑行的估计人均成本（CA$321）占首次住院成本（CA$66 554）的0.5%。骑行加常规物理治疗与单纯常规物理治疗相比，90天成本的人均差异（CA$5841；95%CI，-CA$7666至CA$18 797）和QALYs（-0.0009；95%CI，-0.0185至0.0182）与0无统计学差异。在每获得一个QALY支付意愿阈值为50 000美元时，骑行加常规物理治疗具有成本效益的概率为0.19。
在这项基于试验的经济评估中，对于接受机械通气的成年人，在常规物理治疗基础上增加早期床上骑行与单纯常规物理治疗之间的成本和QALY差异与0无显著差异。这些结果凸显了需要进行更多成本效益研究，考虑关于重症患者床上骑行的全部证据。
