UK Sleep Apnoea Trust annual conference 7th Nov 1998
Question:
In article <364aac4e.7325…@news.megsinet.net>, docd <d…@bigfoot.com> writes [...] >These UK prices are those is US dollars or in pounds?
US Dollars rounded to the nearest $10 Pound Sterling prices: Sullivan V 305 Sullivan V Elite 360 DeVilbiss 8001RD 250 Respironics Solo 340 >docd >>Not so, here are the current UK prices: >>Sullivan V $500 >>DeVilbiss 8001RD $410 >>Respironics Solo $560 >>Whereas you are paying $650 for a Sullivan V, I could buy a Sullivan V >>Elite for $590.
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Response:
In article <3656a749.10763…@news.swbell.net>, "Charles L. Perrin" <clper…@swbell.net> writes [...] >The five years may be right (people have told me that), but I am >correct on the price of a CPAP machine; at least in the United States. >We’re likely a more competitive market than countries where they have >a single-payer system (like most of the rest of the world).
Certainly a competitive market, but the price an insurance company pays for CPAP in the US has been kept in the $1200+ range by greedy DME companies. The DME benefits from that competition when he buys the machine and then pockets a nice fat profit when he sells it to the insurance company. >How about this modest proposal: Give me the aforementioned $1300 to >buy a CPAP machine. I’ll go buy a SULLIVAN V to replace the one that >my insurance is currently renting from a DME supplier (at what I >consider to be a shockingly high rate given what they’re renting, but >it’s "usual, customary, and reasonable" in their rate book). Then, >I’ll take the $650 left over to go play the stock market. That should >buy me about 22 shares of ResMed stock (speaking of SULLIVAN V) just >as soon as they split.
The point is "you" can buy a Sullivan V in the US for $650, but it would be interesting to hear from anybody whose insurance company was billed $650 for the same machine. >Sounds to me like CPAP machines are WAY, WAY overpriced in the UK. >That’s the only thing I can think of… and they say US medical costs >are high?
Not so, here are the current UK prices: Sullivan V $500 DeVilbiss 8001RD $410 Respironics Solo $560 Whereas you are paying $650 for a Sullivan V, I could buy a Sullivan V Elite for $590. >>in the cost of ongoing support and consumables (masks, hoses, filters >>etc.) >I’m fully aware of my costs so far as every single bill crosses my >desk. In two months, I’ve cracked a MIRAGE forehead assembly ($25).
$13 over here. [...] Regards Paul — Paul Kemp anti – spam/UCE measures follow:- :@: E mail :@: Home Page: http://www.kemp.demon.co.uk/ :@: :@: paul@kemp. :@: ICQ Pager: http://wwp.mirabilis.com/1914266 :@: :@: demon.co.uk :@: This is *NOT* my Email address: ab…@demon.net :@:
Response:
On Tue, 10 Nov 1998 21:13:45 +0000, Paul Kemp <paul@_UCE_.NOT_.WANTED> wrote: >In article <3656a749.10763…@news.swbell.net>, "Charles L. Perrin" ><clper…@swbell.net> writes >>The five years may be right (people have told me that), but I am >>correct on the price of a CPAP machine; at least in the United States. >>We’re likely a more competitive market than countries where they have >>a single-payer system (like most of the rest of the world). >The point is "you" can buy a Sullivan V in the US for $650, but it would >be interesting to hear from anybody whose insurance company was billed >$650 for the same machine.
Let me put it this way: If Regence Group (one of the largest Blue Cross systems in the country) can’t get me a CPAP cheaper than I can from http://www.cpapman.com/ or at least give me the option to buy it from them, I’m going to raise Cain with both Employee Benefits and Stockholder Relations about the worthless insurance company they contract with. Since I have to pay 20%, they should give me the option to pay for it myself and get reimbursed. Otherwise, they’re brain-damaged. Particularly because it’s a self-insured plan and Regence Group just passes through employer money. I’m going to make the Real World price perfectly clear to (in writing) to Regence before they buy it from the "usual, customary, but not reasonable to my mind" DME supplier they’re using in Houston. The rental price is shocking to my mind but Regence certifies it as "usual, customary, and reasonable"…. of course, they probably need to load the first month at what they charged as a number of patients wash out, and there are a number of costs related to deploying and retrieving the rental machine…. but EVERY month? My townhouse rental is not much more than my CPAP rental! –C.
Response:
On Wed, 11 Nov 1998 15:25:38 GMT, d…@bigfoot.com (docd) wrote: >These UK prices are those is US dollars or in pounds?
For the avoidance of doubt: Paul Kemp and I both quote prices in US dollars to avoid confusing the majority of people reading the newsgroup who live in the US. We’re astonished at the high prices you people (and your insurers) pay for CPAP. Most consumer products are cheaper in the US than in the UK. It’s often the case that you pay the same price in dollars as we pay in pounds sterling, but a pound is worth US $1.66. This means we pay 66% more for the same thing. Part of the difference is due to our higher sales tax, we pay 17.5% Value Added Tax whereas you pay less than 10% sales tax (and often zero if buying mail order from another state). OK, we pay 0% on medical goods if they are clinically required. I find it’s worth buying such things as computer components, software, some photographic goods and toys from the US even after allowing for UPS shipping and customs clearance costs, import duty and UK sales tax. I collect handmade model trains and buy from the US at about half the UK price. So why is CPAP the exception? Someone, somewhere is making huge profits out of you. Whether it’s your insurers, your DME’s, CPAP manufacturers or someone else, CPAP is big, big, BIG business for someone.
Response:
On Mon, 09 Nov 1998 18:00:35 GMT, n…@polson.NOSPAM.demon.co.uk (Tony Polson) wrote: >On Sun, 08 Nov 1998 19:37:22 GMT, clper…@swbell.net (Charles L. >Perrin) wrote: >>Well, FINALLY, there is something to be said for the US system of >>health insurance. >>Your average half-enlightened employer will do most anything to get an >>experienced and valued employee back to full functioning. OSA isn’t >>that expensive to treat. One CPAP machine costs about $800 USD and >>runs like a workhorse for around ten years. >Not so. CPAP typically costs your insurance company $1300 – $1500 >(and lasts on average for 5 years)
The five years may be right (people have told me that), but I am correct on the price of a CPAP machine; at least in the United States. We’re likely a more competitive market than countries where they have a single-payer system (like most of the rest of the world). How about this modest proposal: Give me the aforementioned $1300 to buy a CPAP machine. I’ll go buy a SULLIVAN V to replace the one that my insurance is currently renting from a DME supplier (at what I consider to be a shockingly high rate given what they’re renting, but it’s "usual, customary, and reasonable" in their rate book). Then, I’ll take the $650 left over to go play the stock market. That should buy me about 22 shares of ResMed stock (speaking of SULLIVAN V) just as soon as they split. Sounds to me like CPAP machines are WAY, WAY overpriced in the UK. That’s the only thing I can think of… and they say US medical costs are high? >in the cost of ongoing support and consumables (masks, hoses, filters >etc.)
I’m fully aware of my costs so far as every single bill crosses my desk. In two months, I’ve cracked a MIRAGE forehead assembly ($25). I have some filters for when it’s time (trivial). Unlike most masks, the ResMed SULLIVAN MIRAGE design consists of a number of FRUs (field replaceable units) so you don’t have to replace the whole mask when something goes "crack" in the night. I’ll see exactly what my long-term expenses are. I suspect that I’ll pay more for cable TV or Internet services (relatively trivial expenses in the USA) than I will for CPAP expendables. >and the cost of outpatient visits to your sleep doctor
Charges $65 a visit, $15 copayment, and has me on a schedule of once every six months. Just keep me out of that sleep lab! >That your insurance company always pays without question (if indeed >that is the case) is not necessarily a good thing.
As soon as my doctor made his recommendation, they put me in the sleep lab. Just as soon as they got the sleep lab results, they called the sleep lab and told them to get me in there for a titration. However, I also make significant co-payments on my medical expenses. >High health insurance (and other "social costs") are a significant factor >in competitiveness and this helps to explain why our economies are >flooded with cheap imports from countries which do not carry such >high social costs.
The US may have high health insurance costs, but the social benefit costs in general are quite low. I suspect we get what we pay for, as (after all) we’re the most productive in the world. Also, environmental regulations DO also have an effect. (Although it may be questionable messing up one country to keep another clean; there’s only one ecosystem.) A lot of it is also overpaid pin-head executives who figure it’s cheaper and easier to market somebody else’s stuff than it is to actually design and build their own. I remember a number of years ago buying my last microwave oven. I had an interesting choice: traditional American brands on boxes that came from the Far East, or traditional Japanese brands that had established assembly and manufacturing capabilities in the United States! And as to flooding with CHEAP imports: Bought a Polish or Yugoslavian car lately? At least in the USA, we have Japanese automobiles. Compared to the local product from Detroit, they’re a more than premium product sold at a premium price. That’s why people buy them. >The study clearly showed that there was little or no reliable research >which demonstrated a sound case for this investment.
Improvement in productivity from lack of EDS should be sufficient for anyone working in a better paying job than McDonalds. I’ll have my managers vouch for that in my case.
Response:
On Tue, 10 Nov 1998 21:13:45 +0000, Paul Kemp <paul@_UCE_.NOT_.WANTED> wrote: >In article <3656a749.10763…@news.swbell.net>, "Charles L. Perrin" ><clper…@swbell.net> writes
These UK prices are those is US dollars or in pounds? docd – Hide quoted text — Show quoted text ->Not so, here are the current UK prices: >Sullivan V $500 >DeVilbiss 8001RD $410 >Respironics Solo $560 >Whereas you are paying $650 for a Sullivan V, I could buy a Sullivan V >Elite for $590. >>>in the cost of ongoing support and consumables (masks, hoses, filters >>>etc.) >>I’m fully aware of my costs so far as every single bill crosses my >>desk. In two months, I’ve cracked a MIRAGE forehead assembly ($25). >$13 over here. >[...] >Regards >Paul
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Response:
On Tue, 10 Nov 1998 03:25:23 GMT, clper…@swbell.net (Charles L. Perrin) wrote: >Sounds to me like CPAP machines are WAY, WAY overpriced in the UK. >That’s the only thing I can think of… and they say US medical costs >are high?
Charles, Please read my posting before replying in such terms. I stated they cost $400-500 here in the UK for CPAPs made in the US and Australia. The prices I quoted for CPAP and sleep studies are US costs taken from 1998 postings on this newsgroup (from people in the good ol’ US of A).
Response:
On Sun, 08 Nov 1998 19:37:22 GMT, clper…@swbell.net (Charles L. Perrin) wrote: >Well, FINALLY, there is something to be said for the US system of >health insurance. >Your average half-enlightened employer will do most anything to get an >experienced and valued employee back to full functioning. OSA isn’t >that expensive to treat. One CPAP machine costs about $800 USD and >runs like a workhorse for around ten years.
Not so. CPAP typically costs your insurance company $1300 – $1500 (and lasts on average for 5 years) and sleep studies $1200 each. Add in the cost of ongoing support and consumables (masks, hoses, filters etc.) and the cost of outpatient visits to your sleep doctor and the costs are very much higher than you suggest. Factor in the poor compliance (say around 50%) and you have an expensive treatment. That your insurance company always pays without question (if indeed that is the case) is not necessarily a good thing. Health insurance costs in the US are acknowledged to be very high by world standards and those costs have to be borne by someone. Employers *appear* to foot the bill, but in a world market the bill needs to be kept low so US companies can compete. High health insurance (and other "social costs") are a significant factor in competitiveness and this helps to explain why our economies are flooded with cheap imports from countries which do not carry such high social costs. >I’ve heard it’s a real battle getting on a CPAP machine in Australia; >where they make the SULLIVAN machines, no less!
I cannot speak for Australia with any authority, but I imagine that most countries outside the US are much more careful when spending money on medical treatment. With cash limits, the UK National Health Service daily has to make difficult and sometimes controversial decisions regarding the allocation of funds. US health care faces similar problems, but history shows that the US is more content than most countries to see insurance premiums simply being raised to pay for the ever-increasing demand. The UK National Health Service has high standards of healthcare and does a pretty good job with very much less money than in most other industrialised countries. Its buying power has helped force down the cost of durable medical equipment. As an example, CPAPs cost from US $400-500 in the UK, including hose and mask. They are the same models as sold in the US, including US-made brands such as DeVilbiss, Respironics and Healthdyne plus Australia’s ResMed. As regards Paul Kemp’s remarks regarding the justification for spending money on treating sleep disorders, a study was funded by the UK’s West Yorkshire District Health Authority with a view to deciding whether investment of their funds in treatment of OSA was justifiable. The review of published research papers in the field of obstructive sleep apnea (OSA) appeared in the British Medical Journal in early 1997. The study clearly showed that there was little or no reliable research which demonstrated a sound case for this investment. Indeed the increased risk of heart attack or stroke so often used in the US for justifying treatment of OSA was not supported by the reviewed research. As a result, West Yorkshire District Health Authority will not automatically fund the provision of treatment for obstructive sleep apnea. Other authorities are reviewing their position but, at the moment, most still fund sleep studies and treatment. Health service managers in the UK will only be convinced that investment is worthwhile if there is a clear and compelling clinical argument based on sound peer-reviewed research. It is unlikely that a clear case can be made on the basis of increased mortality as a result of heart attack or stroke. However it should be possible to prove that there is every reason why OSA should be treated in order to maintain the vitality of the individual and all that implies. Paul Kemp reported a paper presented at the UK Sleep Apnoea Trust annual conference on research carried out by the excellent team at the UK’s Oxford Sleep Clinic led by Dr John Stradling, whose results appear to strongly support that case based on treatment with nasal CPAP. These results, once published, will make a strong contribution to the case for providing treatment of OSA and will be warmly welcomed by those in the sleep disorders field worldwide, not just in the UK.
Response:
On Sun, 8 Nov 1998 15:00:52 +0000, Paul Kemp <paul@_UCE_.NOT_.WANTED> wrote: >Sleepiness is one of the prime reasons for treating OSA. >These test results are more evidence in favour of the supply of CPAP >that can be used on health authorities reluctant to supply CPAP.
Well, FINALLY, there is something to be said for the US system of health insurance. Your average half-enlightened employer will do most anything to get an experienced and valued employee back to full functioning. OSA isn’t that expensive to treat. One CPAP machine costs about $800 USD and runs like a workhorse for around ten years. I’ve heard it’s a real battle getting on a CPAP machine in Australia; where they make the SULLIVAN machines, no less! (One of the three products exported from Australia. The other two are those huge cans of Foster’s Lager and [ironically] classic American rock music CDs that the American music companies see unfit to make. [Double irony -- The group in question is "America."])
Response:
Thanks so much for the informative posting. Let us know when you get your new stuff, and how it works. Best Regards, Deb
Response:
Paul, Thanks for posting this. I’m sorry I couldn’t get to the Conference this year, it sounds like it was a good one. Some good research results too. Much needed, especially if you live in West Yorkshire ! Thankfully I do not. cc by email.
Response:
I went to the above yesterday, and thought you may like to know what was discussed. I have summarised the lectures as best as I can remember, and from the few notes I took. Resmed, DeVilbiss and Respironics were displaying their machines and masks. From Resmed; Some new Mirage mask acessories; Part No. 16524 "Hytrel Tubing"; A more robust form of the short thin tube that connects to the mask. It looks like a thin version of the standard cream coloured air hose. Part No. 16527 "Stability Strap"; A velcro strap that attaches the air hose to the headgear. Part No. 16528 "Extension Piece"; Puts the forehead assembly further up away from the mask (I did not see one but will be ordering one – I will let you all know what it looks like). From DeVilbiss; Nothing much new, but the 8001 CPAP now comes supplied with a colour coordinated grey air hose that matches the colour of the machine. From Respironics; The Solo CPAP now can go up to 16 cm H2O on 12V operation (and there are plans to get it up to 20 cm). Summary of the lectures * Dental devices 35 patients were fitted with the devices and evaluated at night #3, #7 and #28. The results: 4 were still OK at night #28 2 were OK at night #3 but not OK by night #7 8 were unable to tolerate the dental devices The remaining 21 are still getting used to the devices. Conclusions Dental devices may be useful for treatment of 1) snoring alone, 2) mild apnoea, 3) temporary use (weekends etc.) The study is progressing into the use of X rays and CT scans as means of predicting which patients may benefit from dental devices. * Effects of low pressure vs. high pressure nCPAP It has been suggested that lower CPAP pressures may have the same benefit as higher pressures. A group of newly diagnosed patients were split into two groups, one half were set up at 50% of their titration pressure and the other half were set up at their full titration pressure. The patients were evaluated on three criteria; 1) Epworth sleepiness scale, 2) multiple wakefulness test and 3) Quality of life scale SF-36) The results: The group on the reduced pressure showed little or no change in all the tests. The group at full pressure showed significant improvements in all the tests. Conclusion: nCPAP works very well! This study has been submitted to the Lancet, and can be used as overwhelming evidence of the benefits of CPAP. This will be very useful in persuading UK health authorities that providing CPAP is worthwhile. * OSA and driving OSA patients were put on a driving simulator, their ability to steer along a monotonous road for three 30 minute "drives" whilst concentrating on their surroundings was evaluated. The patient had to steer along the middle of a "road" whilst looking out for the appearance of a "2" appearing at the edges of the screen. A group of newly diagnosed OSA patients was split into two groups and as in the previous study one group was put on 50% of their prescription pressure, the other was at their full prescription pressure. The results before and after 4 weeks of CPAP were compared: Before CPAP the ability to keep to the middle of the road was poor and deteriorated as the 30 minute drive progressed. These results were compared to those of a drunk driver and were worse! After CPAP, the ability to keep the centre of the road was virtually the same as that of the general population. The group who were on 50% pressure showed little or no improvement. Conclusion: Sleepiness is one of the prime reasons for treating OSA. These test results are more evidence in favour of the supply of CPAP that can be used on health authorities reluctant to supply CPAP. * Sleep apnoea in children A case study was presented of a 7 year old girl who was suffering from severe OSA caused by enlarged tonsils. She was suffering from all the classic symptoms; daytime sleepiness, headaches, poor school performance, anti social behaviour, loud snoring. Her OSA went after her tonsils were removed. A study showed that 1.1% of children have the same problem. It had been recognised (published in the British Medical Journal) at the end of the 19th century that tonsillectomy could be a "miracle cure" for stupidity and unruly behaviour in children, this was of course without realising that OSA was the cause. This then lead to a massive increase in the numbers of tonsillectomies performed in children, leading up to about 70% of children having their tonsils removed in the 1930’s which has now dropped to about 2% now. It was discussed whether such children may become apneic adults, but there is no data available at present. — Paul Kemp anti – spam/UCE measures follow:- :@: E mail :@: Home Page: http://www.kemp.demon.co.uk/ :@: :@: paul@kemp. :@: ICQ Pager: http://wwp.mirabilis.com/1914266 :@: :@: demon.co.uk :@: This is *NOT* my Email address: ab…@demon.net :@:
