Respironics flexes CPAP

Tuesday, December 31, 2002

MURRYSVILLE, Pa. - A new CPAP technology that provides pressure relief during exhalation is being touted by some as the most significant basic “box” breakthrough in years, if not ever.

Developed by Respironics and now equipped on every REMStar Pro CPAP machine, the new C-Flex technology tracks a patient’s breathing and, during exhalation, lowers the amount of pressure delivered. The ramp-down is not as precipitous as a bi-level drop, but the perception of relief, even from a layman’s appreciation, is substantial.

“C-flex has made CPAP obsolete,” said John Goodman, president of and Health Management Services in Houston. “It’s a wow machine, and we really haven’t seen that since” bi-level CPAP.

In terms of CPAP breakthroughs, providers are hailing the patented C-Flex feature as the most important new aid to compliance since Fisher & Paykel’s work in heated humidification and ResMed’s Mirage mask.

“It’s a night and day difference,” said Renee McPhee, president of Southern Medical in Atlanta. “If I could put everybody on it, that’s all I’d buy. There’s no question.”

Respironics is now conducting clinical trials to demonstrate the benefits of C-Flex. In a recent patient preference trial that involved nine patients, the four who were using C-Flex used the device for 5.83 hours per night. The five who used regular CPAP stayed on the therapy 4.74 hours.

Extrapolating those results out to a statistically significant sample size, say industry watchers, will truly prove the merits of the new technology.

“It sounds good in theory, but we have been around this business long enough to know that sounding good in theory is not enough,” said Ron Richard, ResMed’s vice president of marketing. “With a new mode like this, we really need to know what the long term impact will be on patient compliance, comfort and efficacy.”

Goodman dispatched 50 REMstar Pro units with C-Flex into his patient base Dec. 2. He said it’s “inconceivable” that anyone will call for their old CPAP after starting therapy with C-Flex.

At the same time, and despite the enthusiasm with which they’re heralding the technology, neither Goodman or McPhee anticpate a wholesale conversion to C-Flex for all subsequent purchases. The issue? Cost.

The REMstar Pro costs about 20% more than the REMstar Plus. That cost difference would cut into McPhee’s profit margin, even after she backs out the costs saved by not having to handle CPAP machines that patients can’t handle. About 30% of McPhee’s patients on Respironics machines are now using the higher-end REMstar Pro. She expects that percentage to rise.

Like McPhee, Goodman is buying significantly into CPAP. Where he buys about one REMstar Pro for every Plus machine now, he expects to buy two Pros with C-Flex for every Plus. His patient base is about 80% compliant with CPAP, he said, and he expects to cross out another third of his non-compliant base with C-Flex.

Whether the market at large will be equally compelled to make similar migrations toward C-Flex is anybody’s guess, especially since cost is such a big driver in the CPAP market. About one out of every two CPAPs in use today falls into the base category, below REMstar Plus.

“The [marketplace] issue in CPAP hasn’t been what is the best therapy, the issue has been what can you afford,” said Bob McCoy, an independent researcher at Valley Inspired Products in Burnsville, Minn. HME