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The Snoring & Sleep Apnoea Forums

Why are CPAP machines so expensive?

Share your experiences with CPAP, request help, find out the latest developments ....
Bogof

Re: Why are CPAP machines so expensive?

Post by Bogof » Fri Jul 06, 2007 8:50 pm

Sorry for the late reply, had overlooked the ongoing discussion.

It seems like some of you are reading too much into what I wrote.

Let me quote with added bolding for clarity...
Bogof wrote: IMO [...] Even more so for those who 'choose' to be a tad heavy and develop OSA because of their lifestyle.


1. I say "those", which means that on the flip side I believe there are "others" who do not 'choose' that lifestyle but still get a "tad heavy". Of course I know some people gain weight differently than others. Nowhere did I state all obese people have themselves to blame, that would have been far off the mark indeed.
2. I say 'choose' within inverted comma's to indicate it's obviously not as simple as "Hey, let's get obese!". With that choice I meant more like "Hey, let's not eat fruit and veg but McD's, fish & chips, liters of fizzy drinks and sandwiches from the Co-op and let's forget about exercise, the Eastenders omnibus is much more important." That's the choice I was hinting at.
3. I start the sentence with "In My Opinion", not "The following is fact and I know it all".

Therefore, I'm surprised anyone would find my post offensive, insulting, think that I hurt people, that I'm out to slate people, get upset about my opinion, make people feel worse or advice me to "think more".

I did not say obese people are obese because they chose to be obese so don't pretend I did.

So, now we can all be friends again and yap about more important things in life. :)

PS I have nothing against Eastenders so don't get started on that one :)

kiwi_clay

Re: Why are CPAP machines so expensive?

Post by kiwi_clay » Wed Dec 26, 2007 4:11 pm

Interesting discussion,

I would like to add two points to this discussion, OSA and Obesity have been linked, what is not clear is whether the OSA contributes to the obesity, In my personal experience I think undiagnosed OSA occurred long before obesity, as before treatment for OSA my body had a continual hunger for sugar, went through the route of checks for all the other conditions, and treatment for depression, even though I was adamant to my GP that I was tired, not truly unhappy . I have lost 3 kilo's since starting CPAP.
As regards the expense of these machines there are many factors at play, but even the company's who produce them refer to them as High Margin products,
A perusal of the resmed profit/loss statement suggests a wholesale markup somewhere in the 500% area, the problem being that when it hist the retail shelves you are looking at another 3 to 400% on this price.
Further perverting the market, is the relationship between insurance company's and doctor's in the US and similar country's, the doctor will massively over quote the device knowing that the customer thinks about his bottom line price( maybe 2 to 300 US), but then only pay about half what the patient thinks they are being billed.
Additionally the only company that allows its products to be sold in one country for use in another is Fisher and Paykel this then prevents large retail suppliers truly leveraging their position in the market, to provide their customers great deals.
In speaking to an engineer in the know, we pay for HOSPITAL grade machines, that are expected to perform day in day out in a hospital setting, and we should get the technical backup that tis expense pays for, (I know from personal experience how hard it is to get this), I have been told that it is possible to get technical drawings for some of the earlier machines, that are "hospital research designs", that are not covered by various patents, a patent search is another avenue if you are of a technical bent.
You could also try the US site cpapauction.com...I have only had great results from them

Bill Bolton

Re: Why are CPAP machines so expensive?

Post by Bill Bolton » Fri Dec 28, 2007 11:21 pm

Anonymous wrote: Interesting discussion

To which your unsourced hearsay added nothing useful!

kiwi_clay.

Re: Why are CPAP machines so expensive?

Post by kiwi_clay. » Sun Dec 30, 2007 7:17 am

Bill Bolton wrote:
Anonymous wrote: Interesting discussion

To which your unsourced hearsay added nothing useful!

Sources.
1.Resmed Profit Loss Statement 2005..re High Margin of product and ultimate cost..calculated by taking net sales of CPAP machines, and subtracting net costs..Resmed comments in their own statement that they are low on profitability at the time of the statement, but greater market penetration will result in a healthy 2007-8 financial return.
2. In talking to Engineer...this was to a personal friend who sell parts to one of the larger manufacturers, his comments were that the machines are made to suit a hospital application, and we could soon see a number of stripped down models to suit end users who do not need all the bells and whistles...for many of us the machine stopping is more of a big inconvenience than a life/death situation..Return of the Zombies
3. Export Restrictions, I was relying on an email that I received from one of the US online resellers, after some extra research It appears that this was an internal decision of the company, tho' I found it strange that F&P would be shipped but not the others??

4. Retail Markup..personal local experience, I was initially directed to a local reseller in my immediate home area, I got very poor service and a take it or leave it attitude on a machine quoted at 1500 dollars, another local online supplier stated their actual markup in their website , and even assuming they get a bulk discount the difference was jaw dropping (And yes they had an in home fitting service, and guaranteed 24 hour warranty turnaround with free interim machines), I have in the end got a Fisher and Paykel 604, with 431 mask..total cost $450, including shipping, on local sites I have seen the same machine for up to $1500.

5. Obesity/OSA links...often mentioned on many sites but this paper is worth a good look http://news.robertfayle.com/sleep/archives/000006.html,
of note lean type 1 diabetics have a higher incidence of sleep apnoea than
obese type 2 diabetics.

6. Service difficulty, in a hospital setting if you have a problem with a machine, and you supply to a hospital you have every expectation that a service guy will be there ASAP (justifiably)..part of this service cost is covered by the markup on the sale of the machinery(usually the basis of service calls here is that if the problem is machine related they wear the cost of the call, if operator related the hospital pays), yet we in Aussie pay as much as if not more than the hospital's, but are far from likely to get this service (Though the service is excellent in comparison to other retail lines), I have read of others (including on your own site) who have been left hanging by their suppliers

7. Behaviour of Insurance Companys in the US....no quotes here but do have a read of the US discussion groups

8. I am expressing an opinion on the two topics in discussion on this thread and am attempting to answer some of the questions posed, I do not believe a truly free market operates on these products as the patent laws favour early entrants..but then I am happy with the price I paid for the benefit I got..your members just need to be aware of the trade offs of using an overseas supplier, and be prepared to dicker with the suppliers..they want as much of your hard earned as they can get..do not just glumly accept the quoted price as the bottem line !

7.

Guest

Re: Why are CPAP machines so expensive?

Post by Guest » Sun Dec 30, 2007 2:38 pm

Bill Bolton wrote: To which your unsourced hearsay added nothing useful!


And that intemperate comment is hardly is hardly contributing anything to the discussion either Mr Bolton.

This is a discussion forum and as such Kiwi_Clay is entitled to an opinion and therefore to make a contribution no matter what your own personal view may be.

kiwi_clay

Re: Why are CPAP machines so expensive?

Post by kiwi_clay » Wed Jan 02, 2008 2:02 pm

Bill Bolton wrote:
Anonymous wrote: Interesting discussion

To which your unsourced hearsay added nothing useful!


Well it is not hearsay as I have where possible quoted my sources,
(Resmed statement available at Resmed.com, buy shares with money you save on machines !)
Another factor that seems to be missing from this discussion is the "Rolls Royce/BMW" analogy,
At the present time most company's seem to be pretty much competing mainly on features of their machines, eg Thermosmart (tm), C-Flex (tm) etc etc,
Now I will agree that for many people these features help to get compliance with the treatment, and for some (eg CSA sufferers) they are essential but they also are used by the manufacturers to distinguish their machine in a dog eat dog market, what sticks out is that no-one seems to sell the mini minor model..i.e exactly and only what you must have, made as minimalist as possible, but this should happen eventually.
for example I have myself found that over time I have been able to dispense with ramp up etc etc.. and probably could have acclimated eventually..(I managed compliance of 7.5 hrs/night in my first two weeks hooray ), for some this is an essential function, for others not so necessary.
I would say the essential needs would be
1. Machine will shut down if any hazard detected
2. Machine supplies air at required pressure, Flow and Humidity
3. Machine has a 6000 hr plus life cycle
4. Parts and service readily available,
5. Machine is relatively quiet,
6. Machine can be adjusted by user for altitude etc without too much bother
would any other essential requirements spring to mind.

Bill Bolton

Re: Why are CPAP machines so expensive?

Post by Bill Bolton » Mon Jan 07, 2008 1:27 am

kiwi_clay wrote: Well it is not hearsay as I have where possible quoted my sources,

Which still appear to be entirely hearsay.

kiwi_clay

Re: Why are CPAP machines so expensive?

Post by kiwi_clay » Tue Jan 08, 2008 8:06 am

Bill Bolton wrote:
kiwi_clay wrote: Well it is not hearsay as I have where possible quoted my sources,

Which still appear to be entirely hearsay.


Since when is quoting a document issued by a company hearsay !,
(2005..2006 resmed profit loss statement at resmed.com/en=us/ select investor and dig a little)
Local internet supplier CPAPaustralia.com.au...current price for 608 $1250, was $1555 at the time I penned my letter, US supplier same machine http://www.cpapusa.com/item.php?product ... PAP+System
$520, (and ships for an extra $100 approximately),
I could no longer get a quote on the machine that I use as the 608 has superseded it,
now I might be stupid, but I fail to see how the local supplier can justify 2 1/2 times the price, and this is the "cheap" internet supplier..now I do not know the firms name but the firm my sleep specialist referred me to the prices started at 2000, and they would only supply one brand !

I am not going to go to the lengths to provide links to every quote but the answer to the question of why are machines so expensive is many fold.
1. They are manufactured to a high reliability standard..this is good
2. They contain technology that many times is still under patent, many of these features are great for some groups of patients, this however does allow for competition on the basis of features not price
3. They are manufactured in western country's to high levels of quality assurance
4. There are a limited number of suppliers or retailers in any market, mainly because of this being a "new" issue for many in the medical field..this unfortunately can lead to predatory pricing for those unable to seek better deals
5. In many country's they are primarily funded by insurance company's, tho this is good for their customers the suppliers do tend to incorporate the cost of these processes in their prices, (for example one of the US Internet suppliers is broken in two, one side for insurance related claims, the other for direct cash customers)
6. Caliber of sales medical staff, engineers etc..being medical related cos they are forced to pay market rates for their highly trained staff..this later shows in both the bottom line and pricing of goods
7. Specifically related to costs of masks..I have worked in the rubber moulding industry and looking at the seals they would be real Pricks to manufacture, as many would probably tear as they were removed from their moulds
8. Ongoing research..both of the local companies put 5% plus of their revenues into research
9. Risk..CPAP is only round 25 years old, potentially it could be a huge time bomb for any of these companies, anything from dust etc from the compressor, carcinogens in the masks etc could show up in the next twenty years, now I fervently hope this is not the case, but we have already seen recalls of both masks and machines for minor faults
10. Cost of capital..as a somewhat risky medical venture each of these companies wants to earn what they can while they can, each is open to the risks of recalls, patent infringements, losing technology edge etc etc.
11. I will also comment on the RESMED financial result last year, gross profit was 50% of revenue (approx) a damn good result,
And probably a dozen more factor`s
Now to the summary, there are both good and not so good reasons for the price levels in cpap machinery, in general hunt for a good deal, but listen to your doctor,be prepared to negotiate, and play hardball with your local supplier..remember it`s a free market out there

(And yes bill I have seen the link to the resmed tango..I hope this helps many people)

WIZZY

Re: Why are CPAP machines so expensive?

Post by WIZZY » Tue Jan 22, 2008 3:20 pm

:shock: Blimey, I am new to this having been diagnosed just before the Christmas Hols, you guys need to chill or is it irritability from the OSA? My 2 main points are that as far as I can see compared to some equipment the CPAP machine seems good value for what they do, the data they record and the high standards set for them to function without fail, so much so, that I am considering an APAP as I seem to tolerate that machine better than a CPAP and I will have to pay for it! As for the obesity issue I think some people are a tad over-sensitive about the comments made. I do not believe the comments made were intended to insult or hurt anyone. The medics were a little surprised at the size of me when I walked in to their clinic, in that, I was only 14 stone at 6 foot in height, whereas normally their patients are at the 20 stone plus mark and they have identified obesity in some people as the cause of their OSA. In my case it is due to genetics, narrow passages, short jawline, etc. But, it has to said, although I have not fully settled to my treatment due to mask problems I have started to lose weight and this is down to OSA affecting the metabolism. When OSA is treated properly it can assist some people with their weight and their health issues. Correspondingly, it may not help others and some may be overweight/obese due to other reasons and it is up to them to gain help from the medical system to ease or cure their health problems, and not I would suggest, have a moan at someone on a forum for making a valid, however generalised, statement. In my work environment with something like this I would be told to dry my eyes princess and get on with it, however, they really are insensitive and it is better to either ignore or laugh it off!!!!! Keep smiling, onwards and upwards!! :lol:

Guest

Re: Why are CPAP machines so expensive?

Post by Guest » Wed Jan 23, 2008 11:20 am

I am a recently diagnosed (although chronic) OSA sufferer; I am also diabetic (Type II), and although CPAP machines (and insulin pumps) are very expensive, on the other hand blood glucose meters are ridiculously cheap, they can even be had free in some cases.

So much for the conspiracy theory; it's more likely to be simple supply and demand (the lower the demand for something, the higher the price has to be in order for the costs to be recovered).

Incidentally, what (if anything) is the difference between CPAP and NIV?

robert@fm

Re: Why are CPAP machines so expensive?

Post by robert@fm » Thu Jan 24, 2008 12:11 pm

My apologies, the above "Guest" post is in fact mine; I forgot to log in.

kiwi_clay

Re: Why are CPAP machines so expensive?

Post by kiwi_clay » Fri Jan 25, 2008 8:56 am

Anonymous wrote: :shock: Blimey, I am new to this having been diagnosed just before the Christmas Hols, you guys need to chill or is it irritability from the OSA? My 2 main points are that as far as I can see compared to some equipment the CPAP machine seems good value for what they do, the data they record and the high standards set for them to function without fail, so much so, that I am considering an APAP as I seem to tolerate that machine better than a CPAP and I will have to pay for it! As for the obesity issue I think some people are a tad over-sensitive about the comments made. I do not believe the comments made were intended to insult or hurt anyone. The medics were a little surprised at the size of me when I walked in to their clinic, in that, I was only 14 stone at 6 foot in height, whereas normally their patients are at the 20 stone plus mark and they have identified obesity in some people as the cause of their OSA. In my case it is due to genetics, narrow passages, short jawline, etc. But, it has to said, although I have not fully settled to my treatment due to mask problems I have started to lose weight and this is down to OSA affecting the metabolism. When OSA is treated properly it can assist some people with their weight and their health issues. Correspondingly, it may not help others and some may be overweight/obese due to other reasons and it is up to them to gain help from the medical system to ease or cure their health problems, and not I would suggest, have a moan at someone on a forum for making a valid, however generalised, statement. In my work environment with something like this I would be told to dry my eyes princess and get on with it, however, they really are insensitive and it is better to either ignore or laugh it off!!!!! Keep smiling, onwards and upwards!! :lol:


Sorry If I was perceived as unnecessarily sensitive,
I tried to answer the question without an in depth analysis and got shot down, so then went back and verified my sources,
I am in the situation that I have no choice but to purchase my own machine,, therefore I took time to research properly, and query what I was told,
You might be interested to pursue the paper that I quoted re diabetes and OSA..it seemed to be worth a good read and perusal of It's sources,
And yes the OSA could have something to do with it, I am noticing that I am becoming more and more placid over the last month or so.
I do not class the low end machines as out of this world expensive, however I also feel that when patents end that we will see significant drops in these low end machines.
Again good luck with your treatment

Mr Sleep

Re: Why are CPAP machines so expensive?

Post by Mr Sleep » Fri Feb 29, 2008 3:25 pm

i was told i had apnea by my gp, and my wife has watched me struggle for breath most of my sleeping time, maybe been overweight in people doesnt help, i however run 40 miles a week
i have been to see a specialist and my airways in my nose are narrow, so i bought a AUTO CPAP from the states for £500 with 2 masks no prescription that includes all the shpping and VAT everything. sad thing is i feel i have wasted the last 8 years struggling through the day
Assuming everyone was like this.

since i used my CPAP its like been given a new head, wh ere did the grumpy me go.

Sleepybiker

Re: Why are CPAP machines so expensive?

Post by Sleepybiker » Tue Mar 04, 2008 7:53 pm

Hi Mr Sleep,

I am amazed you could get a machine with no prescription. I would have liked to have done that to forestall the no driving / risk to driving license difficulties.

The machine I have is set by the sleep technicians. Did you find any problems with yours?

I felt better with the auto machine they lent me when they were assessing the pressure to set my machine to than now. It is early days for me as this is now night 21 but I am keen to learn about what options are out there. I was not told much by the sleep techs etc.

Regards,

Martin

Bill Bolton

Re: Why are CPAP machines so expensive?

Post by Bill Bolton » Tue Mar 04, 2008 11:06 pm

Sleepybiker wrote: I am amazed you could get a machine with no prescription.
[/quote]
Generally, the various national regulatory environements for Healthcare only require you to have prescription if you are resident in the nation involved.

Sometimes finding a seller who will ship across borders can be a challenge but not having a perscription per se is usually not an issue in those circumstances. Some US sellers so ask for a prescriptions from non-US residents though its not legally required, and in my expereince it is usually not worthwhile trying to argue over that... just move on and find another seller.

Cheers,

Bill

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