Inspire Medical Systems (INSP) Q4 2024 earnings summary

Executive summary

• Surpassed 90,000 patients treated, achieved over 350 peer-reviewed publications, and received U.S. FDA approval for Inspire 5 neural stimulator and EU MDR approval with full-body MRI compatibility.

• Achieved first full year of profitability in 2024, with net income of $53.5M and expanded leadership and organizational structure to support growth.

• Expanded to 1,435 U.S. medical centers and 335 sales territories, with robust clinical adoption and digital scheduling at 300 centers.

• Launched new digital tools, expanded medical education and patient engagement programs, and transitioned to the SleepSync digital health platform.

• Received a civil investigative demand from the DOJ regarding marketing, promotion, and reimbursement practices; company intends full cooperation.

Financial highlights

• Q4 2024 revenue was $239.7M, up 25% year-over-year; full year revenue reached $803M, a 28% increase from $625M in 2023.

• Q4 net income was $35.2M ($1.15 per share), up from $14.8M ($0.49 per share) in Q4 2023; full year net income was $53.5M ($1.75 per share) versus a net loss of $21.2M in 2023.

• Gross margin for Q4 was 85%; full year gross margin was 84.7%.

• Adjusted EBITDA for Q4 was $62.7M (26% margin), and for the year $157.8M (20% margin).

• Operating cash flow was $69M in Q4 and $130.2M for the year; cash and investments totaled $517M at year-end.

Outlook and guidance

• 2025 revenue guidance is $940M–$955M, representing 17–19% growth year-over-year.

• 2025 gross margin expected between 84% and 86%; diluted net income per share guidance is $2.10–$2.20.

• Operating margin improvement expected, with profitability not anticipated in Q1 due to seasonality but sequential improvement expected throughout the year.

• Interest income projected at $20M for 2025.

• Full launch of Inspire V anticipated in 2025.