The Cost-Effectiveness of Early Active Mobilization During Mechanical Ventilation in the ICU: An Economic Evaluation Alongside the Treatment of Mechanically Ventilated Adults With Early Activity and Mobilization (TEAM) Trial

Objectives: Early mobilization is recommended by the Society of Critical Care Medicine ICU Liberation Bundle. The Treatment of Mechanically Ventilated Adults With Early Activity and Mobilization (TEAM) randomized controlled trial (RCT) compared early active mobilization to usual care mobilization and found no difference in the primary outcome of days alive and out of hospital to day 180; however, it did find an increase in adverse events in the intervention group. To date, no RCT of early mobilization has reported costs or cost-effectiveness. We aimed to determine the cost-effectiveness of early active mobilization from the perspective of the healthcare sector. Design: We conducted a prospective, within-trial cost-effectiveness analysis alongside the TEAM study. Setting: Forty-nine ICUs in six countries (Australia, New Zealand, United Kingdom, Ireland, Germany, and Brazil). Patients: The cost-effectiveness analysis included 733 adult ICU patients who were undergoing invasive mechanical ventilation and enrolled in the TEAM study. Interventions: Early active mobilization or usual care mobilization Measurements and Main Results: A significantly higher number of hours were spent by staff in delivering high-dose early active mobilization vs. usual care mobilization; however, incremental costs were not significantly different between the groups ($1,823; 95% CI, -$10,552 to $12,027). EuroQoL-5D 5-level utility scores at 6 months were not significantly different between the groups (0.532 [se, 0.021] vs. 0.548 [se, 0.021]; p = 0.585). The probability of early active mobilization being cost-effective is less than 50%, even at a willingness-to-pay threshold of $200,000/quality-adjusted life year (QALY). Sensitivity analyses incorporating meta-analysis data indicated that early active mobilization may be cost-saving; however, this involves the occurrence of lower QALY gains when compared with usual care mobilization. Conclusions: Our trial-based analysis found no evidence that higher-dose early active mobilization is a cost-effective intervention compared with usual care mobilization for mechanically ventilated adult ICU patients; however, results from sensitivity analyses provided some evidence that it may be cost saving if one is willing to accept poorer outcomes. Further research is necessary to determine whether there are scenarios in which early active mobilization provides value for money.