They clearly are speaking of the market the MPDD resides in as having an estimated $4.5 billion in device sales, etc. etc. You have misinterpreted the statement whether by accident or not.
15,000 x $15,000(avg.) = $225,000,000 + recurrent, etc.
If anything, it's poor grammar. Should have read,
The combined national and international market, for the MPDD device, is estimated at $4.5 billion dollars annually in device sales and recurrent education and training revenues.
which could be reworded to,
"For the MPDD device, the combined national and international market is estimated at $4.5 billion dollars annually in device sales and recurrent education and training revenues."
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