This Figure now repeats the results shown in Figures 14 and 16, this time from the payer perspective for a hypothetical population of 1000 severe COPD patients.  The top left panel shows the annual costs to the payer.  For patients who are receiving no NIV, the cost of the payer in that first year is over $25 million, primarily due to readmissions.  For patients who are on NIPPV, there is a significant reduction in readmissions, with the cost savings driven by that reduction.  However there is now an increase in reimbursement that the payer is having to provide for the device itself, roughly $20 million in that first year and declining in years thereafter.  Thus despite the increased reimbursement required for the device, over this 5-year period there is a cumulative savings of roughly $14 million to the payer, driven mainly by the reduction in readmissions.