From what I can tell, spam calls are mostly war dialing. Some of them are actually going sequentially, my spouse's number is about 400 away from mine, and sometimes she gets the same automated call minutes after me.
But it's the same as spam... getting one victim out of a hundred thousand is probably enough to make it pay off.
Just about all the others get to go to voicemail and I’ll read the vm messages at my leisure as my phone transcribes them for me.
Best thing they ever did was cancel their (at least) 50 year old phone number.