Inspire Medical Systems vs Penumbra

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KIRA’s take AI analyst

I put Inspire Medical Systems and Penumbra side by side, using each one’s latest annual report. Here is what stands out:

Penumbra is the larger business, with $1.4B of revenue in fiscal 2025 against $912M for Inspire Medical Systems, about 1.5 times as much.
Penumbra grew revenue faster (17.5%, against 13.6%).
Penumbra kept more of each dollar of sales as operating profit (13.5% operating margin, against 5.6%).
Penumbra turned more of its sales into free cash flow (12.5% FCF margin, against 8.6%).
Penumbra earned a higher return on the capital invested in it (18.8%, against 14.2%).
Investors pay more for each dollar of Penumbra’s earnings: a P/E of 79.7x against 15.7x for Inspire Medical Systems.

Who comes out ahead

Of the 11 measures where higher (or lower) is clearly better, how many each company leads.

Inspire Medical Systems

INSP

6/11

5-year growthGross marginNet marginReturn on equityNet debt / EBITDAShare count change

Penumbra

PEN

5/11

Revenue growthOperating marginFCF marginReturn on capitalPiotroski F-score

Side by side

Best in the row

Latest fiscal year	INSP FY25	PEN FY25
Size
Market cap	$2.1B	$12.8B
Revenue	$912M	$1.4B
Free cash flow	$78.5M	$175M
Net income	$145M	$178M
Growth
Revenue growth	13.6%	17.5%
5-year growth	51.2%	20.2%
Share count change	−2.6%	0.1%
Profitability
Gross margin	85.4%	67.1%
Operating margin	5.6%	13.5%
Net margin	16.0%	12.7%
FCF margin	8.6%	12.5%
Return on capital	14.2%	18.8%
Return on equity	19.8%	13.8%
Balance sheet
Net debt	−$308M	−$522M
Net debt / EBITDA	−4.8x	−2.5x
Dividends and buybacks	$175M	$0.0M
Valuation & quality
P/E	15.7x	79.7x
Piotroski F-score	5	7

Ten years

Revenue

FY16

INSP $16.4M

PEN $263M

FY17

INSP $28.6M

PEN $334M

FY18

INSP $50.6M

PEN $445M

FY19

INSP $82.0M

PEN $547M

FY20

INSP $115M

PEN $560M

FY21

INSP $233M

PEN $748M

FY22

INSP $408M

PEN $847M

FY23

INSP $625M

PEN $1.1B

FY24

INSP $803M

PEN $1.2B

FY25

INSP $912M

PEN $1.4B

FY16 FY17 FY18 FY19 FY20 FY21 FY22 FY23 FY24 FY25

INSP PEN

Operating margin

FY16

INSP −105.0%

PEN −0.5%

FY17

INSP −56.0%

PEN 0.4%

FY18

INSP −40.3%

PEN −0.2%

FY19

INSP −42.5%

PEN 8.7%

FY20

INSP −48.7%

PEN −7.0%

FY21

INSP −17.1%

PEN −1.0%

FY22

INSP −11.7%

PEN 0.7%

FY23

INSP −6.5%

PEN 7.0%

FY24

INSP 4.5%

PEN 0.8%

FY25

INSP 5.6%

PEN 13.5%

FY16 FY17 FY18 FY19 FY20 FY21 FY22 FY23 FY24 FY25

INSP PEN

Free cash flow

FY16

INSP −$18.3M

PEN −$26.4M

FY17

INSP −$16.2M

PEN $0.2M

FY18

INSP −$18.9M

PEN $19.2M

FY19

INSP −$35.6M

PEN $4.5M

FY20

INSP −$55.5M

PEN −$58.0M

FY21

INSP −$24.8M

PEN −$11.7M

FY22

INSP $2.5M

PEN −$75.0M

FY23

INSP $1.0M

PEN $82.1M

FY24

INSP $91.1M

PEN $147M

FY25

INSP $78.5M

PEN $175M

FY16 FY17 FY18 FY19 FY20 FY21 FY22 FY23 FY24 FY25

INSP PEN

Return on capital

FY16

INSP —

PEN −0.5%

FY17

INSP —

PEN 0.4%

FY18

INSP —

PEN −0.2%

FY19

INSP —

PEN 11.2%

FY20

INSP —

PEN −7.3%

FY21

INSP −106.8%

PEN −1.1%

FY22

INSP —

PEN 0.4%

FY23

INSP −40.6%

PEN 8.4%

FY24

INSP 18.5%

PEN 0.7%

FY25

INSP 14.2%

PEN 18.8%

FY16 FY17 FY18 FY19 FY20 FY21 FY22 FY23 FY24 FY25

INSP PEN

Each company's latest fiscal year; fiscal years end in different months. The best value in each row is highlighted where higher (or lower) is clearly better. Not investment advice.