MDxHealth SA Annual Report - How They Did This Year

I’ve put together this guide to help you understand MDxHealth’s performance. Instead of digging through dense financial filings, we will break down the key takeaways so you can decide if this company fits your investment goals.

1. What does this company do?

MDxHealth creates advanced diagnostic tests for urology, focusing on prostate cancer. They provide data to help doctors decide if a patient needs an invasive biopsy or can safely monitor their condition. Their core tests include Confirm mdx, GPS mdx, and the Exo mdx liquid biopsy. They are also expanding into the urinary tract infection market with their Resolve mdx test, which identifies infections faster than traditional methods.

2. Financial health: The "Going Concern" warning

The company is in a "growth phase," spending more cash than it brings in. As of December 31, 2024, they reported a total loss of $403 million over the company's life and a $33.5 million loss for the year. While they generated $76.8 million in revenue, high costs from scaling the business remain a challenge. They also carry $40 million in debt. If they miss specific financial targets, the lender could demand immediate repayment, which would likely cause a major cash crisis.

3. The "Three-Test" Strategy & New Growth

The company aims to manage a patient’s entire journey, from initial screening to long-term monitoring.

• The Science: Their tests are clinically proven. The Exo mdx test is 91% accurate at identifying patients who can safely avoid a painful, risky prostate biopsy.
• The Pipeline: They are developing Monitor mdx, a urine-based test for men already under "active surveillance." This test aims to reduce the need for repeat biopsies, which often carry risks of infection.

4. The Insurance "Black Box"

MDxHealth records revenue based on what they expect to collect, not their list prices.

• Medicare Reliance: About 44% of their revenue comes from Medicare, which offers stable but limited payments.
• The Risk: Billing is complex because they often work "out-of-network" with private insurers. They must estimate how much they will actually get paid. If an insurer pays less than expected, the company must lower its reported revenue. They are now working to sign "in-network" contracts to make their cash flow more predictable.

5. Why your investment is "High-Stakes"

• Accounting Issues: In 2025, the company identified a "material weakness" in how they track revenue. This means their accounting systems were not strong enough to guarantee accurate financial reports, which increases the risk of future errors.
• Takeover Vulnerability: Since leaving the Brussels stock exchange, they no longer have standard takeover protections. This makes them an easier target for a buyout, which might happen at a price you dislike.
• Dilution: To pay debts and fund operations, the company sells more shares. This reduces your ownership percentage in the company.

6. Future outlook

MDxHealth is racing to become profitable before they run out of cash. Their success depends on three things: getting more doctors to use their tests, signing contracts with private insurance companies, and fixing their accounting systems. This is a speculative investment. Success depends on growing sales while managing a very tight budget.

Investor Checklist: Before you decide, ask yourself:

• Risk Tolerance: Am I comfortable with a company that has a "going concern" warning and ongoing accounting challenges?
• Growth Potential: Do I believe their "in-network" insurance strategy will successfully stabilize their cash flow?
• Timeline: Am I prepared for the possibility of share dilution as they continue to fund their operations?