At the risk of being very cynical, which do you think makes more money for the pacemaker manufacturer (and doctor and hospital, etc): a pacemaker with an eternal nuclear battery, or one that has to be replaced every few years?
That would make way more sense if the average age of a pacemaker recipient was much younger. I don't get the feeling that they'd be eliminating that many units for sale - figure the average age of a first time pacemaker recipient is in their 60s or 70s; you're talking 2 or maybe 3 units in total.
That number rises of course with people who get them much younger (which is the case in my family), but even then you're not talking about a gross amount of units. Maybe 7 or so in a lifetime.
I'm sure the up-front cost of the pacemaker is greater when it has a nuclear battery. As far as doctor and hospital? I doubt that they factor into the equation when Medtronic makes their business decisions.
I completely disagree with your second point. The manufacturer necessarily markets almost exclusively to the doctor. Most patients will happily go with whatever their doctor says is the best device on the market. And health insurance is probably paying for it anyway, so it's not like the vast majority of people receiving pacemakers actually have to make the decision based on the cost of the device.
Any differentiation between product lines will have to do with ease of implantation, ease of servicing or other clinician-facing features.
