MDXH — MDxHealth S.A.

MDxHealth S.A. Q4 2025 Earnings Call Summary

1. Key Financial Results and Metrics

• Revenue: Q4 revenue was $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, up 14% from $4.6 million in the prior year, primarily due to increased headcount and expenses from the ExoDx acquisition.
• Net Loss: Rose 31% to $8.9 million compared to $6.8 million in Q4 2024, influenced by higher financial expenses.
• Adjusted EBITDA: Reported at negative $2.1 million for Q4, compared to negative $1.4 million in Q4 2024. The company expects to reach a 10% EBITDA margin by the end of 2026.
• Cash Position: Cash and cash equivalents stood at $29 million as of December 31, 2025.

2. Strategic Updates and Business Highlights

• Acquisition of ExoDx: Integration of ExoDx began in Q4, successfully transitioning SelectMDx customers to ExoDx, enhancing operational efficiencies.
• Volume Growth: Total billable volume reached 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 Improvement: The turnaround time for tissue-based patient samples improved to five days or less, enhancing customer satisfaction.
• Clinical Partnerships: Progress on the GPS PROMPT study with the University of Oxford, expected to enhance the utility of MDxHealth’s tests in clinical guidelines.

3. Forward Guidance and Outlook

• 2026 Revenue Guidance: The company projects revenue between $137 million and $140 million for 2026, implying approximately 28% year-over-year growth.
• Growth Drivers: Guidance is based on unit growth from customer adoption and contributions from the ExoDx acquisition, with a focus on balancing revenue between tissue and liquid biopsy products.

4. Bad News, Challenges, or Points of Concern

• Increased Operating Losses: The operating loss and net loss have increased, raising concerns about the impact of the ExoDx acquisition on short-term profitability.
• Cash Burn: Higher cash flow usage than in previous quarters raises questions about future financing needs, especially as the company integrates ExoDx.
• ASP Decline: Average selling prices (ASP) for tissue tests decreased, attributed to a mix shift towards lower-priced products, which could impact revenue.

5. Notable Q&A Insights

• ASP Dynamics: Management confirmed that ASP fluctuations are influenced by product mix, with no immediate concerns about denial rates affecting revenue.
• Cash Flow and Financing: The leadership expressed confidence in managing cash burn and highlighted the relief from the Exact Sciences earnout amendment, which defers payments and provides flexibility.
• Operational Leverage: There is a commitment to maintain flat operating expenses while achieving top-line growth, with expectations of improved operating leverage as the integration of ExoDx progresses.

Overall, MDxHealth S.A. demonstrated solid revenue growth and strategic advancements in Q4 2025, though challenges related to increased losses and cash burn remain points of concern as the company integrates its recent acquisition.