Inspire Medical Systems (INSP) Q4 2025 earnings summary

Executive summary

• Q4 2025 revenue grew 12% to $269.1M; full year revenue rose 14% to $912M, with a five-year CAGR of 50%, driven by growth at existing and new centers and strong Inspire V adoption.

• Net income for Q4 was $136.1M, with diluted EPS of $4.66; full year net income was $145.4M, with EPS of $4.89, aided by a tax valuation allowance release.

• Inspire V system demonstrated superior clinical outcomes, with a 79.5% responder rate in Singapore and low device revision rates; over 90% of centers now implanting Inspire V.

• FDA approval for 3.0T MRI compatibility and launch of SleepSync digital platform enhanced product value and patient engagement.

• Completed $175M in share repurchases in 2025.

Financial highlights

• Q4 net income per diluted share was $4.66; adjusted EPS $1.65; full year EPS $4.89, adjusted $2.42.

• Q4 operating cash flow was $52M–$53M; full year $117M.

• Gross margin reached 86.6% in Q4 and 85.4% for FY2025.

• Adjusted net income for FY2025 was $72.15M, with adjustments for stock-based compensation, legal fees, asset impairment, and a non-recurring tax benefit.

• Year-end cash and investments totaled $404.6M–$405M.

Outlook and guidance

• 2026 revenue guidance is $950M–$1B, representing 4%–10% growth, with adjusted operating margin expected at 6%–8%.

• 2026 net income per diluted share guidance: $1.23–$1.81; adjusted: $1.85–$2.35.

• Effective tax rate projected at 44%–49%; adjusted effective tax rate 26%–28%.

• Capital expenditures for 2026 expected between $45M–$50M.

• Q1 2026 revenue expected to be flat year-over-year, with a net loss anticipated due to higher operating expenses.