Healthcare · Medtech
Installed Base and Pull-Through
Systems, users and procedures as medtech's demand engine: filed installed-base KPIs for Intuitive and Abbott Libre, Stryker Mako, and pull-through maths.
Selborne Research · Medtech coverage: 7 guides, 6 company profiles, a primer and Excel model
Educational analysis for professional use. This guide is not investment advice or a recommendation to buy or sell any security, and it is not personalised.
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The Installed Base Earns Next Year’s Revenue
A medtech installed base is the stock of placed platforms, active users or cumulative procedures that keeps buying consumables without a new capital sale. The chain: systems (or users) × procedures per system × pull-through per procedure = recurring revenue, where pull-through is the consumable revenue each procedure generates.
Only two large device makers file a group installed-base count; for the rest you work from segments or procedure economics. Razor-and-blade economics shows where pull-through lands in the P&L.
Filed Installed-Base KPIs (FY2025)
| Company | Installed-base metric | FY2025 value | Procedure / usage growth |
|---|---|---|---|
| Intuitive Surgical | da Vinci surgical robots installed | 11,106 (+12% vs 9,902 prior year) | ~3.15M procedures +18% |
| Intuitive Surgical | Ion lung-biopsy robots installed | 995 | Ion procedures +51% |
| Abbott | Libre glucose-monitor users worldwide | >8 million | Diabetes Care revenue $7,998M |
| Stryker | Cumulative Mako robot procedures (knee and hip) | >2.0 million | Organic sales growth 10.3% |
| Boston Scientific | WATCHMAN heart-implant patients, cumulative | >600,000 treated (milestone) | Not a placement count |
| Medtronic | Group KPI | Not filed | Segment commentary only |
| Edwards Lifesciences | Implant / centre count | Not filed | TAVR heart-valve revenue $4.5B (+8.6% at constant currency) |
Stryker’s “>3,000 Mako systems” comes from the Q4 2025 earnings call, not an SEC filing; the filed figure is >2.0M cumulative procedures.
Intuitive Surgical: Systems × Procedures × Pull-Through
| Metric | FY2025 value |
|---|---|
| da Vinci installed base | 11,106 systems |
| Worldwide da Vinci procedures | ~3.15M (+18%) |
| Instruments and accessories (I&A), the single-use tools each operation consumes | $6,018.9M (59.8% of $10.1B total) |
| I&A per da Vinci procedure (pull-through) | $1,810 (flat YoY) |
| Recurring revenue (company definition) | 84% of total |
Procedures grew +18% and the installed base +12%, so each robot did more work. Revenue can accelerate even when placements slow.
Abbott: Users as the Installed Base
Abbott files no group recurring share, so the Libre user count stands in.
| Metric | FY2025 value |
|---|---|
| Libre users worldwide | >8 million |
| Diabetes Care segment revenue | $7,998M |
| Group organic growth | 5.5% (6.7% ex COVID testing) |
| Group GAAP gross margin | 52.6% (56.4% before amortisation) |
Diabetes Care is broader than continuous glucose monitoring (CGM); there is no full-year CGM line, though Q4 CGM sales were $2.0B. The user count still shows how many sensors are active and reordering.
The model works like Intuitive’s, but without a recurring share Abbott cannot be placed on the >70% / 40–70% / <40% screen in the razor-and-blade guide.
When There Is No Count at All
Edwards Lifesciences files no implant, centre or procedure count. Demand shows up as TAVR revenue: $4.5B, 74% of $6.1B net sales, growing +8.6% at constant currency. The demand unit is still the procedure, as the procedure-volume guide explains.
Boston Scientific’s >600,000 WATCHMAN patients treated is a clinical milestone and does not belong in the same formula as 11,106 da Vinci systems.
Worked Example: Utilisation on 11,106 Systems
Using Intuitive’s FY2025 filed figures:
| Step | Calculation | Result |
|---|---|---|
| Procedures per system | 3,150,000 ÷ 11,106 | ~284 procedures/system/year |
| I&A per da Vinci procedure | Filed pull-through | $1,810 |
| I&A per system (implied) | 284 × $1,810 | ~$514,000/year |
| da Vinci I&A (check) | 3.15M × $1,810 | ~$5.7B (vs $6.0B of all I&A) |
The da Vinci arithmetic lands about $0.3B short of reported I&A because the $1,810 counts da Vinci procedures only. Most of the gap is instruments for Ion, Intuitive’s lung-biopsy robot, which ran about 144,100 procedures. If procedures keep growing +18% and systems +12%, procedures per system rise about 5% a year ((1.18 ÷ 1.12) − 1).
A Count Is Not a Recurring Share
Installed-base counts inform the recurring-mix judgement without replacing it. Intuitive is the only company here with both a count and a filed recurring share: its 84% sits in the razor/blade band above 70%. Stryker’s >2.0M cumulative Mako procedures show adoption, and its leases bring in under 4% of revenue, but like Medtronic, Abbott, Boston Scientific and Edwards it files no recurring share, so none of the five can be put in a band on disclosed data.
Read Abbott for Libre and Diabetes Care, and Intuitive Surgical for the full recurring bridge.
A franchise DCF charges reinvestment for every point of growth, fades that growth year by year, and asks how many years of it a price pays for.
- 15 sections, installed base and pull-through to a franchise DCF, the runway a price implies and growth-adjusted P/E
- 44 pages
- a razor-blade franchise and a diversified grower
- 2 worked archetypes
- large-cap device makers on filed organic growth, margins and free cash flow
- 6-company screen
The Excel model is the primer's franchise DCF live across 11 sheets: a razor-blade franchise and a diversified grower valued over 20 years on funded free cash flow, with growth held for a runway and then faded to terminal, an operating margin path and a WACC built from the cost of equity and after-tax debt; a runway table showing how many years of growth the illustrative price pays for; a valuation summary; the installed-base build; P/E implied by the DCF value and by the price, each growth-adjusted; organic-versus-reported checks; and a sensitivity grid. Change organic growth, the runway, ROIC or the WACC and the value moves.
See what's in the Medtech Sector Primer →£25 PDF · £59 with the Excel model · £159 for all three Healthcare industries
Frequently Asked Questions
- What is an installed base in medtech?
- Placed capital units (da Vinci robots), cumulative procedures on a proprietary platform (Mako), or active users (Libre). ISRG filed 11,106 da Vinci systems and 995 Ion systems at 31 Dec 2025. Abbott filed more than 8 million Libre users worldwide.
- How does installed base drive recurring revenue?
- Each procedure or active user consumes proprietary consumables. ISRG generated $1,810 of I&A revenue per da Vinci procedure in FY2025 on ~3.15M da Vinci procedures (+18%), about $5.7B. Total I&A was $6,018.9M (59.8% of revenue, +19%); most of the difference is instruments for Ion, its lung-biopsy robot.
- Which medtech companies do not file installed-base counts?
- Medtronic, Boston Scientific and Edwards publish no consolidated installed-base KPI in FY2025 filings. SYK files cumulative Mako procedures (>2.0M) but no system count in the 10-K. BSX cites >600,000 cumulative WATCHMAN patients treated, a milestone rather than a count of devices placed.
- How do you value a company without an installed-base metric?
- Use revenue that stands in for procedures (EW TAVR, 74% of $6.1B sales) or segment growth rates. Where a company files a group recurring share, read it against the recurring-mix screen (>70% razor/blade, 40-70% hybrid, below 40% capital-cycle); the procedure-volume guide covers demand without a capital count.
Read next
Razor-and-Blade Economics in Medtech
How capital platforms convert to recurring pull-through: ISRG 84% recurring mix, I&A at $1,810 per da Vinci procedure, recurring-revenue screens, and a worked 5,000-system example.
Procedure Volumes: the Demand Unit
Clinical utilisation as medtech demand: EW TAVR 74% concentration, ISRG 3.15M procedures, SYK Mako cumulative volume, and revenue without a capital installed-base KPI.
See it applied
These company profiles apply the concepts from this guide to real public companies.