BiPAP/Bi-level Versus Ventilator

Dear Andrea,
Do I really need to keep this expensive ventilator?  My friend has a BiPAP that costs her so much less.  Should I just ask to switch to that? 
Sincerely,
"Cash-strapped" ventilator user

Dear "Cash-strapped" ventilator user,
One of the most frequent topics of discussion in our Facebook based Breathe with MD Support Group is "Should I use the ventilator prescribed or switch to a cheaper BiPAP for noninvasive ventilation?  My monthly payments to the DME are too expensive."

This is a tough question to answer.  It should be addressed with your NMD respiratory care team.  One place to start that conversation is to ask what specifically about the ventilator is necessary for your respiratory care that is not offered on a less pricey bi-level device (a BiPAP).  

For example, are you using the ventilator, because it offers the option to enable more than one prescription such as one for day use and another for nighttime use? Are you maybe using the ventilator because you're on a mode of volume-based support or a combination of pressure and volume support? Or, are you using active circuit ventilation on the ventilator with the EPAP (Expiratory Positive Airway Pressure) as zero?  If so, switching to a basic bi-level device such as a BiPAP is not going to be a solution for you, as a BiPAP won't offer these options.

Below is a listing that compares the two devices and may help you to understand why one device might be more suited to your situation versus the other. 

Bi-level/BiPAPs offer:

• Typically pressure support; don't offer volume-based support
• Are smaller in size and lighter in weight
• Batteries are generally not standard 
• Fewer alarms can be enabled
• Cost of ownership/rental is less than ventilators
• Rental caps, meaning you eventually own the device with no ongoing payments 
• Less costly than ventilators

Ventilators offer:

• Higher pressure settings
• Multiple modes of ventilation (pressure, volume, and a combination of pressure and volume)
• Dual or multiple prescription setup (i.e. day mode, night mode, etc.)
• Multiple batteries (internal and external)
• Flexibility to be used for non-invasive ventilation and later invasive ventilation via tracheostomy 
• Lifetime DME rental, meaning you will not be able to "rent to own"
• Rental cost typically includes manufacturer's recommended service, supplies, and 24/7 support 
• A cost that is significantly more than basic bi-level devices

I hope this information helps you navigate this decision about which device to use for your mechanical/assisted ventilation. Remember, have a discussion about this with your NMD care team.  Don't be afraid to ask questions and express concern about the cost fitting into your  budget.  

Wishing you all the best,
​Andrea

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