I completely disagree with your second point. The manufacturer necessarily markets almost exclusively to the doctor. Most patients will happily go with whatever

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.