INTRODUCTION: No formal cost-effectiveness analysis has been performed for programs of cycling exercise during dialysis (intradialytic cycling (IDC)). The objective of this analysis is to determine the effect of a 6-month program of IDC on health care costs. METHOD(S): This is a retrospective formal cost-effectiveness analysis of adult participants with end-stage kidney disease undertaking in-center maintenance hemodialysis enrolled in the CYCLE-HD trial. Data on hospital utilization, primary care consultations, and prescribed medications were extracted from medical records for the 6 months before, during, and after a 6-month program of thrice-weekly IDC. The cost-effectiveness analysis was conducted from a health care service perspective and included the cost of implementing the IDC intervention. The base-case analyses included a 6-month "within trial" analysis and a 12-month "within and posttrial" analysis considering health care utilization and quality of life (QoL) outcomes. RESULT(S): Data from the base-case within trial analysis, based on 109 participants (n = 56 control subjects and n = 53 IDC subjects) showed a reduction in health care utilization costs between groups, favoring the IDC group, and a 73% chance of IDC being cost-effective compared with control subjects at a willingness to pay of GBP 20,000 and GBP 30,000 per quality-adjusted life year (QALY) gained. When QoL data points were extrapolated forward to 12 months, the probability of IDC being cost-effective was 93% and 94% at GBP 20,000 and GBP 30,000 per QALY gained. Sensitivity analysis broadly confirms these findings. CONCLUSION(S): A 6-month program of IDC is cost-effective and the implementation of these programs nationally should be a priority.

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