Inspire Medical Systems (INSP) Q4 2024 earnings summary

Executive summary

• Surpassed 90,000 patients treated, achieved over 350 peer-reviewed publications, and received 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 $802.8M–$803M in revenue (28% growth), and expanded leadership and organizational structure.

• Expanded to 1,435 U.S. medical centers and 335 sales territories, with over 260 million U.S. covered lives and more than 1,200 employees.

• Launched new digital tools, expanded medical education and patient outreach, and transitioned to SleepSync™ digital health platform and ADHERE 2.0 registry.

• 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 $802.8M–$803M, a 28% increase.

• Q4 net income was $35.2M (15% margin), up from $14.8M in Q4 2023; full year net income was $53.5M (7% margin) vs. a $21.2M loss in 2023.

• Q4 diluted EPS was $1.15 vs. $0.49 in Q4 2023; full year diluted EPS was $1.75 vs. a loss of $0.72 in 2023.

• Q4 adjusted EBITDA was $62.7M (26% margin); full year adjusted EBITDA was $157.8M (20% margin).

• Operating cash flow for 2024 was $130M–$130.2M; cash and investments totaled $516.5M–$517M at year-end.

Outlook and guidance

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

• 2025 gross margin expected at 84%–86%; diluted net income per share projected at $2.10–$2.20.

• Tax rate for 2025 expected to be roughly 10%; diluted shares outstanding projected at 31M.

• Sequential improvement in profitability expected after Q1, with seasonality impacting Q1 results.

• Full launch of Inspire V anticipated in 2025.