MDXH — MDxHealth S.A.

MDxHealth S.A. Q4 2025 Earnings Call Summary

1. Key Financial Results and Metrics

• Revenue: Q4 revenue reached $29.5 million, a 19% increase from $24.7 million in Q4 2024. Full-year revenue totaled $107.9 million, slightly below the pre-release estimate by $1 million.
• Gross Profit: Q4 gross profit was $18.7 million, up 20% year-over-year, with gross margins at 63.2%, a slight increase from 62.7% in Q4 2024.
• Operating Loss: Increased to $5.3 million in Q4 from $4.6 million in the prior year, attributed to higher headcount and operating expenses from the ExoDx acquisition.
• Net Loss: Rose 31% to $8.9 million compared to $6.8 million in Q4 2024, impacted by increased financial expenses.
• Adjusted EBITDA: Reported at negative $2.1 million for Q4, worsening from negative $1.4 million in Q4 2024.
• Cash Position: Ended Q4 with $29 million in cash and cash equivalents.

2. Strategic Updates and Business Highlights

• Acquisition of ExoDx: Successfully integrated ExoDx, transitioning SelectMDx customers to ExoDx, which is expected to enhance operational efficiencies and expand the product menu.
• Volume Growth: Total billable volume was approximately 38,000 tests in Q4, with liquid-based tests increasing by 128% year-over-year, while tissue-based tests saw a 5% decline.
• Customer Experience: Improved turnaround time for tissue-based samples to five days or less, enhancing customer satisfaction.
• Clinical Collaborations: Progress on the GPS PROMPT study with the University of Oxford, which is expected to bolster the utility of MDxHealth’s tests in clinical guidelines.

3. Forward Guidance and Outlook

• 2026 Revenue Guidance: Projected revenue of $137 million to $140 million, implying approximately 28% year-over-year growth, driven by unit growth and integration of ExoDx.
• EBITDA Margin Target: Aiming for a 10% adjusted EBITDA margin by the end of 2026, reflecting confidence in operational efficiency and revenue growth.

4. Challenges and Points of Concern

• Increased Operating Losses: The operating loss and net loss have widened, raising concerns about the company’s profitability trajectory amidst rising expenses.
• Cash Burn: Higher cash usage in Q4 compared to previous periods raises questions about future financing needs.
• ASP Decline: Average selling prices (ASP) for tissue tests decreased, attributed to a mix shift towards lower-priced tests, which could impact revenue per test.

5. Notable Q&A Insights

• ASP Discussion: Management confirmed that ASP fluctuations are influenced by the mix of tests sold, particularly between Confirm and GPS tests.
• Cash Flow and Financing: Executives expressed confidence in managing cash burn and indicated that the amendment to the Exact Sciences earnout provides financial flexibility.
• Growth Drivers: The integration of ExoDx is expected to enhance growth, with a focus on cross-selling to existing customers and leveraging the combined customer base for increased sales.

Overall, MDxHealth S.A. demonstrated solid revenue growth and strategic advancements in Q4 2025, despite facing challenges related to profitability and cash flow management. The company remains optimistic about its future growth trajectory, particularly with the integration of ExoDx and ongoing clinical collaborations.