My current understanding is that the 406 MHz emitting beacons (EPIRB for marine use, ELT for aviation, PLB for personal use) provide a stronger signal that would be more reliable under conditions where terrain or weather could hamper a signal reaching satellites (5W 406 MHz for the ACR ResQLink PLB vs 0.4W 1610 MHz for the SPOT. I haven't worked out yet if it's the higher wattage, lower frequency, or combination of both that makes it "stronger"). And while having a unit with GPS capability and clear view of the sky/satellite helps pinpoint location more quickly/accurately beyond doppler triangulation, 406 MHz emitting radiobeacons don't require a clear view of the sky to get through. The 406 MHz digital signal can get rescuers within 5km, and with a unit like the ACR ResQLink, the weaker 121.5 MHz homing signal can be utilized by air-craft or ground crews to zero in. If you can get the GPS coordinates sent out, even better; accuracy is 15m but because of the limitations of transmitting the information to the satellite, GPS coordinates will put responders within 125m. Furthermore, the PLBs operate on the same COSPAS-SARSAT system as EPIRBs and ELTs, vs. the Globalstar commercial satellite system that SPOT uses. COSPAS-SARSAT covers the entire globe, apparently, and is international and government/non-profit/humanitarian. Globalstar is profit-driven, and apparently has gaps in coverage (poles, south africa, should be fixed this year though) and there seem to be reliability issues. I would rather put my trust in COSPAS-SARSAT rather than Globalstar. There is some nuance in response time too, from activation of signal, but I haven't quite got all that straight yet.
So basically, I think PLBs provide a more reliable signal to a more reliable satellite network, and is therefore more likely to get you rescued.
In addition, I think the cost of the PLB unit (I've had my eye on the ACR ResQLink+ = $289 retail from REI) + Registration/Service (Free to use COSPAS-SARSAT, $40 or $60 yearly if you want confirmation of self-tests from ACR ) is cheaper over the long term vs. the SPOT ($150 retail REI) + annual subscription ($100 per year). To clarify, you can buy the ACR and do a limited number of self-tests (60), but this just lets you know that the unit is functioning and transmitting, not that the entire signaling process ran to completion. If you want that added security, you have to buy the subscription, which gets you email or text confirmation that a signal was sent.
Lastly, while SPOT does offer more options in terms of tracking and communicating with loved ones at home, with a $60 subscription purchase from ACR (still cheaper than SPOT) I can basically send the same "I'm ok" messages via a PLB through a self-test. So if I'm running late, or sprained an ankle or something but can still self-rescue and prevent paying for an unnecessary SAR call-out, I can just do a self-test to let loved ones know I'm OK even though I'm over-due. One note, I think this messaging service only applies to the Americas and Pacific and Atlantic oceans, which is fine with me. Anyway, aside from the contact-with-loved-ones, I'd want the subscription just to confirm that the entire system -- from signal to alert/receipt -- works before trips (annual subscription gets you 220 self-tests). I don't really want or need the tracking features SPOT offers. I just want something that will signal reliably if I am ever in a truly bad situation where self-rescue isn't possible. An argument can be made for the bread-crumbs approach to rescue, but I would rather have a strong and reliable signal when I actually need it. And if I am capable and have to move, a PLB like the ACR transmits for up to 30 hours in "typical conditions", a burst every 50s.
Plus, I don't know how accurate this is, but I have this impression that the PLBs are constructed to be much more robust than SPOT or other such SENDs.
Anyway, I'm still digging into the nitty gritty of it all, but this is more or less what I've gleaned that's led me to prefer a 406 MHz emitting PLB over a SEND like SPOT. I'm sure there's stuff I've missed or fumbled over, but I've been trying to form a complete and unbiased picture from various sources. And of course, take this all with a grain of salt, as I don't have any first-hand experience, and I have come across some seemingly compelling arguments for SENDs. Some interesting stuff by Doug Ritter
here. Judging by his take, the 406 beacons on COSPAS-SARSAT are functionally superior, at least for the time being, but the consumer market is pushing things towards SENDs.