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MDXH, MDxHealth SA

Life Sciences Tools & Services consumer brand UnprofitableDistress / turnaround

We are a commercial-stage precision diagnostics company providing non-invasive, clinically actionable and cost-effective urologic solutions to improve patient care.

We have established a systematic approach to bring our precision diagnostic solutions to market, centered on proactive engagement, education, and market expansion aimed at healthcare professionals and their patients.

Building from the foundation of our complementary marketed products, we are committed to sustained growth, with our core management principles defined by a commitment to focus, commercial execution and operating discipline throughout our organization.

Latest annual: FY2025 20-F · 1 ADS = 10 ordinary shares

MDXH · MDxHealth SA

The business

What it sells, where the money comes from, the kind of company it is.

Revenue · FY2025

$108M

+19.8% YoY · 42% 5-yr CAGR

Vital signs · TTM, with 5-yr average

Revenue $108M 5-yr avg $65M

Gross margin 65% 5-yr avg 58%

Operating margin −13.4% 5-yr avg −60.5%

ROIC −32% 5-yr avg −80%

Owner-earnings margin −3% 5-yr avg −52%

Free cash flow margin −3% 5-yr avg −53%

The business in brief

read the 10-K →

What this business is and what moves its needle, from its own SEC filings.

What it is: Revenue is Tissue-based revenue (76%) and Liquid-based revenue (24%).
Situation: Unprofitable. No sustained operating profit across the record; an earnings multiple has nothing to rest on. What the record does show is revenue, the gross-margin trajectory, and the burn against the cash on hand. Distress / turnaround. Thin interest coverage, or operating cash burned against real debt, across the record. The balance sheet carries this situation; the debt schedule sets the clock.
What moves the needle: Operating margin has run around −102% through the cycle on a 52% gross margin, the operating line in the red even at its best — so the lever is whether the spending below the gross line can come down enough to clear a profit: revenue growth against the cost curve, and the cash runway until it does. The cash cycle has run negative through the cycle (a median of −30 days): the operation is paid before it pays, so working capital releases cash as the business grows rather than tying it up. Read this kind of business on volume, payer mix and reimbursement. On its own account, the filing leans hardest on pricing power & competition, set against the numbers in what the filing emphasizes, below.
Is it a good business?: Return on capital has rarely cleared the cost of capital (median −104%, above 15% in 0 of 4 years). Owner earnings, the cash-based check, have been thin too. This is price-taker territory, where the balance sheet and the cycle matter more than any multiple; the rest is in the 10-K.

Every line is arithmetic on the company's filings, shown in full in the sections below.

Where the money comes from

read the 20-F →

Tissue-based revenue is 76% of revenue, with Liquid-based revenue the other meaningful line at 24%.

Revenue by product line, FY2025

Tissue-based revenue76%$81M
Liquid-based revenue24%$26M
Royalties and other revenues0%$326K

From the segment footnote of the company's own 20-F. Shares are of total revenue; the profit bar shows each segment's share of segment operating profit, before unallocated corporate costs.

The record

Ten years of arithmetic, read across the cycle.

The record, 2019–2025

realized figures from each filing · older years to the left

2019’19	2020’20	2021’21	2022’22	2023’23	2024’24	2025’25	TTMTTMDec 2025
								Income statement
$12M	$18M	$22M	$37M	$70M	$90M	$108M	$108M	RevenueRevenue
0%	44%	48%	52%	63%	61%	65%	65%	Gross marginGross mgn
($43M)	($27M)	($27M)	($38M)	($27M)	($25M)	($14M)	($14M)	Operating incomeOp. inc.
−366.3%	−146.9%	−120.7%	−102.3%	−38.9%	−27.5%	−13.4%	−13.4%	Operating marginOp. mgn
($43M)	($29M)	($29M)	($44M)	($43M)	($38M)	($34M)	($34M)	Net incomeNet inc.
								Cash flow & returns
($22M)	($20M)	($23M)	($34M)	($21M)	($19M)	($2M)	($2M)	Operating cash flowOp. cash
$2M	$2M	$880K	$965K	$2M	$3M	$4M	$965K	DepreciationDeprec.
$19M	$7M	$6M	$9M	$19M	$16M	$27M	$30M	Working capital & otherWC & other
$73K	$537K	$896K	$3M	$3M	$1M	$1M	$1M	CapexCapex
0.6%	2.9%	4.0%	7.5%	3.9%	1.3%	1.1%	1.1%	Capex / revenueCapex/rev
($22M)	($21M)	($23M)	($35M)	($24M)	($20M)	($3M)	($3M)	Owner earningsOwner earn.
−189.7%	−112.6%	−105.4%	−94.7%	−34.5%	−21.9%	−3.1%	−3.1%	Owner earnings marginOE mgn
($22M)	($21M)	($23M)	($37M)	($24M)	($20M)	($3M)	($3M)	Free cash flowFCF
−189.7%	−112.6%	−105.4%	−99.6%	−34.5%	−21.9%	−3.1%	−3.1%	Free cash flow marginFCF mgn
-173%	—	—	—	-106%	-103%	-32%	-32%	ROICROIC
-219%	-490%	-62%	-473%	-598%	-257%	—	—	Return on equityROE
−219%	−490%	−62%	−473%	−598%	−257%	—	—	Retained to equityRetained/eq
								Balance sheet
—	$16M	$58M	$16M	$22M	$47M	$29M	$29M	Cash & investmentsCash+inv
—	$4M	$5M	$9M	$11M	$14M	$15M	$15M	ReceivablesReceiv.
—	$2M	$2M	$2M	$3M	$4M	$7M	$7M	InventoryInvent.
—	$5M	$7M	$10M	$9M	$8M	$10M	$10M	Accounts payablePayables
—	$775K	($962K)	$2M	$5M	$10M	$11M	$11M	Operating working capitalOper. WC
—	$23M	$67M	$29M	$38M	$67M	$53M	$53M	Current assetsCur. assets
—	$13M	$16M	$18M	$20M	$43M	$50M	$50M	Current liabilitiesCur. liab.
—	1.8×	4.1×	1.6×	2.0×	1.6×	1.1×	1.1×	Current ratioCurr. ratio
$1M	—	$0	$36M	$36M	$36M	$3M	$39M	GoodwillGoodwill
—	$32M	$75M	$119M	$129M	$157M	$148M	$148M	Total assetsAssets
—	—	—	—	$36M	$51M	$76M	$76M	Total debtDebt
—	—	—	—	$13M	$4M	$47M	$47M	Net debt / (cash)Net debt
-83.7×	-17.6×	-12.4×	-5.9×	-1.5×	-1.6×	-0.6×	-0.6×	Interest coverageInt. cov.
$20M	$6M	$47M	$9M	$7M	$15M	($12M)	($12M)	Shareholders’ equityEquity
								Per share
3.5M	125M	18.3M	23.8M	38.9M	49.3M	50.0M	50.0M	Shares out (diluted)Shares
$3.37	$0.15	$1.22	$1.56	$1.81	$1.83	$2.16	$2.16	Revenue / shareRev/sh
$-12.33	$-0.23	$-1.59	$-1.85	$-1.11	$-0.77	$-0.67	$-0.67	EPS (diluted)EPS
$-6.40	$-0.17	$-1.28	$-1.47	$-0.62	$-0.40	$-0.07	$-0.07	Owner earnings / shareOE/sh
$-6.40	$-0.17	$-1.28	$-1.55	$-0.62	$-0.40	$-0.07	$-0.07	Free cash flow / shareFCF/sh
$0.02	$0.00	$0.05	$0.12	$0.07	$0.02	$0.02	$0.02	Cap. spending / shareCapex/sh
$5.64	$0.05	$2.56	$0.39	$0.19	$0.30	$-0.24	$-0.24	Book value / shareBVPS

The diluted share count moved ×35.71 into 2020 — shares issued, not a split the totals corroborate — and the per-share figures carry the counts as filed.

The diluted share count moved ×1/6.82 into 2021 — shares retired, not a split the totals corroborate — and the per-share figures carry the counts as filed.

The diluted share count moved ×1.63 into 2023 — shares issued, not a split the totals corroborate — and the per-share figures carry the counts as filed.

Share counts before 2025 are restated ×1.5 for a stock split, so per-share figures sit on one basis.

Per-share growththe realized rate an owner's share compounded

	6-yr	5-yr
Revenue / share	−7.2%/yr	+70.9%/yr
Capital spending / share	+1.7%/yr	+40.0%/yr

The record, charted

FY2019–2025

Each measure over its full record; the current point and the worst year marked. Share counts on the current split basis.

Share count

50Mpeak FY2020

ROIC

−32%low FY2019

Gross margin

65%low FY2019

Owner earnings vs. net income

Owner earningsNet income

The accountant's number, and the cash an owner can take; the gap is the tell.

($3M)owner earningsvs.($34M)net incomelow FY2022

Owner-earnings bridge

FY2021–FY2025cash-flow statement, SEC EDGAR →

Net income is the accountant's number; owner earnings is the cash an owner could take out. The walk between them, off the cash-flow statement, and whether the gap is widening or holding.

In fiscal 2025 the business turned a $34M loss into ($3M) of owner earnings: more cash than the profit line showed, after the non-cash charges and the capital it put back in.

	FY2025	FY2024	FY2023	FY2022	FY2021
Reported net income	($34M)	($38M)	($43M)	($44M)	($29M)
Depreciation & amortizationnon-cash charge added back	+$4M	+$3M	+$2M	+$965K	+$880K
Working capital & othertiming of cash in and out, other non-cash items	+$27M	+$16M	+$19M	+$9M	+$6M
Cash from operations	($2M)	($19M)	($21M)	($34M)	($23M)
Maintenance capital expenditurethe spending needed just to hold position and volume	−$1M	−$1M	−$3M	−$965K	−$896K
Owner earnings	($3M)	($20M)	($24M)	($35M)	($23M)
Growth capital expenditurediscretionary; spent to get bigger, not to stand still	—	—	—	−$2M	—
Free cash flow	($3M)	($20M)	($24M)	($37M)	($23M)
Owner-earnings marginowner earnings ÷ revenue	-3%	-22%	-35%	-95%	-105%

Owner earnings is the cash an owner could pull out without starving the business: operating cash less the capital it must spend to hold its position .

Maintenance capex is estimated as depreciation where a growing business invests above it; free cash flow is the figure the scorecard's free-cash margin reads.

III

Quality & stewardship

Returns, the balance sheet, capital allocation, and pay.

Owner’s Scorecard

FY2025 20-F · source on SEC EDGAR →

Will it survive?

Can it pay its interest? -0.6×

Does not cover its interest

Operating income ($14M) ÷ interest expense $23M

What this means
A full year of operating profit didn't cover the interest bill. This is the zombie zone: the business depends on refinancing, asset sales, or forbearance to service its debt.
How heavy is the debt, net of cash? $47M

Net debt against an operating loss

Cash $29M − debt $76M

What this means
Netting $29M of cash and short-term investments against $76M of debt leaves $47M owed, with no operating profit this year to measure it against — understand that combination before anything else about the company. Net debt is the leverage figure that matters: the cash is already set against the debt. Strategic or illiquid investments aren't counted here.
How long is cash tied up? 15d

Tight

DSO 50 + DIO 64 − DPO 99 days

What this means
Days cash is tied up between paying suppliers and collecting from customers. Lower is better; a long cycle means growth itself eats cash.

Is it a good business?

Return on invested capital -106%

Below average through the cycle

4-yr median, range -173%–-32%; -32% latest = NOPAT ($11M) ÷ invested capital $35M

Industry peers: median -26%

What this means
The rate the business earns on the money tied up in it, Buffett's north star, because over time a stock tracks the ROIC beneath it. Above ~15% sustained hints at a moat; a return below the cost of capital (~8%) erodes value as a business grows rather than building it — the test Buffett weighs most. The headline is the median of the last 4 years (it ran -32% most recently), so one peak or trough year doesn't set the verdict. Asset-light businesses (R&D expensed, little capital) read artificially high, pair this with Owner Earnings.
Owner-earnings margin -95%

Consumes cash through the cycle

7-yr median margin, range -190%–-3%; latest ($3M) = operating cash ($2M) − maintenance capex $1M

Industry peers: median -30%

What this means
What an owner could take out without starving the business: operating cash less the maintenance capital it must spend to hold its position — Buffett's owner earnings. That's -3% of revenue this year, a -95% median across 7 years.
Are earnings backed by cash? ($2M)

Loss, and burning cash

Net income ($34M) · cash from operations ($2M)

What this means
The company reported a net loss, so a conversion ratio isn't meaningful. What matters then is whether operations still threw off cash, here, they did not.

How is the cash used?

Where do the earnings go? —

Not enough data

What this means
The filing data didn't include the inputs for this check.
Investing or harvesting? 1.20×

Maintaining

Capex $1M ÷ depreciation $965K

What this means
Descriptive, not a grade. Above ~1× means investing faster than assets wear out (growth, or, sustained for years, today's earnings carrying less depreciation than tomorrow's will). Below means spending less than it's wearing out (efficiency, or a melting asset base). The ratio won't tell you which; the filings will.

Graham’s defensive tests · 0 of 5 met

Graham’s numerical criteria for the defensive investor (The Intelligent Investor, ch. 14), run on the filings. A floor of safety, not a buy signal; many fine modern businesses fail his strictest liquidity rules by design.

Adequate size Miss

Revenue ≥ $2B · $108M

What this means
Big enough to weather a storm. Graham's 1972 floor was ~$100M of sales (≈ $700M today); we use a $2B revenue line as a conservative modern stand-in.
Strong liquidity Miss

Current ratio ≥ 2× · 1.08×

What this means
Current assets at least twice current liabilities, near-term bills covered without touching the business. Strict by design: many cash-rich modern firms run leaner and miss it, holding their cushion in longer-dated securities.
Conservative debt Miss

Debt ≤ working capital · $76M vs $4M WC

What this means
Graham's rule that borrowings not exceed net current assets. Capital-heavy and buyback-heavy firms routinely fail it, read it next to interest coverage, not alone.
Earnings stability Miss

A profit every year (7-yr record) · 7 loss years

What this means
Graham wanted earnings in each of the past ten years, the stability a defensive owner leans on.
Dividend record Miss

Uninterrupted dividends · none paid

What this means
An unbroken dividend was Graham's mark of durability. He wanted twenty years; the filings show about ten, and a single suspension breaks the streak. Non-payers, many fine modern compounders, fall outside his defensive net by design.
Earnings growth —

Earnings +33% over the record · —

What this means
Earnings were negative early in the record, a growth rate isn't meaningful.
Moderate price —

P/E ≤ 15 and P/E × P/B ≤ 22.5 · decided by the price

What this means
Graham's valuation gate, the wall he kept between a sound business and a sound investment. Three-year average earnings are $-0.74/share (latest year $-0.65), the averaged base the calculator's gate runs on, and book value is $-0.24/share. Enter a price in “What the price implies” just below for the P/E, P/B, and whether it clears. But this is the rule Buffett outgrew: there's no hard P/E law, and a wonderful business can deserve a far richer multiple if the thesis holds, treat it as the bargain-hunter's floor, not a verdict on the price.

Durability & moat, 2019–2025

Whether the record’s returns held, and what the capital reinvested earned.

Profitable years 0 of 7

What this means
Lost money in 7 year(s), look at what happened there before trusting the average.
Return on capital ≥ 15% 0 of 3 yrs

What this means
A moat shows up as a high return on invested capital that holds year after year, not one good vintage.
Operating margin −211% → −27% (3-yr avg ends)

What this means
Through the cycle the operating margin widened — about −211% early to −27% lately, median −102% — pricing power intact or improving.
Reinvestment, incremental ROIC returns capital

What this means
The capital base barely grew: this business returns cash through dividends and buybacks rather than reinvesting. Judge it on the cash returned, not on compounding.
Worst year 2019 · −366.3% op. margin

What this means
Operations went underwater in 2019, understand why before trusting the good years.
How management talks about it Owner’s terms

What this means
The record and the register agree: capital is compounding and the filing reasons in an owner’s terms — per-share value, return on capital, the long term — not a promoter’s.

Does AI threaten the moat?

Moderate contestability

AI is likely to reshape costs and some products here without clearly contesting or sparing the core moat; how the company itself frames it is the tell.

In its own filing Named as a competitive risk

Its FY2025 10-K names artificial intelligence as a competitive threat.

“We may also face increased competition from other companies that are employing AI and related technologies, some of whom may develop more effective methods than we and any of our commercial partners have, which could have a material adverse effect on our business, results of operations, or financial condition.…”

The question is whether a moat the record shows as durable outlasts a technology that lowers the cost of part of what the firm sells. The durability is read in the record above, the filing's own framing of AI beside it; the industry label decides nothing on its own.

Read from the filing's own risk factors, paired with the industry's structure under its SIC code; the durability is read above, the price below.

All figures as filed; the source filing is linked above.

Current Position

as of fiscal year-end, Dec 31, 2025

Can the business pay what it owes this year, off the freshest balance sheet: the quality of the assets, the debt actually coming due, and what a low ratio means here.

Current assets$53M

Cash & short-term investments$29M
Receivables$15M
Inventory$7M
Other current assets$3M

Current liabilities$50M

Accounts payable$10M
Other current liabilities$39M

Current ratio1.08×all current assets ÷ what's due · Graham looked for 2×

Quick ratio0.94×stricter: inventory excluded

Cash ratio0.59×strictest: cash alone against what's due

Working capital$4Mthe cushion left after near-term bills

Cash runway8.7 yrsthe business is consuming cash; this is how long the cash on hand lasts at that rate

Deeper floors

Tangible book value($90M)equity stripped of goodwill & intangibles

Net current asset value($107M)Graham's net-net: current assets less all liabilities

Debt incl. operating leases$87M$10M of it operating leases

From the company's latest filing.

Acquisitions & goodwill

from the balance sheet & the 7-year cash-flow record

Goodwill grows only when a company acquires and falls only when it concedes it overpaid. The size of that bet, the cash put into buying rather than building, and how much has already been written off.

Goodwill & intangibles$78M53% of all assets; the premium carried on the balance sheet for businesses acquired

Against book equity—goodwill is this share of book equity; the rest is the company’s own retained and paid-in capital

Cash spent acquiring$0over 7 years buying other businesses, against $9M of capital spent building

None written down over the record; the goodwill is still carried at full cost. That is the deals holding their value on the books so far; whether they keep doing so is the test an owner watches, since the write-down, when it comes, is the admission the price was too high.

Goodwill, acquired intangibles and equity from the latest balance sheet; acquisition spend and write-downs summed across the 7-year record, from the company's own filings.

Peers, Life Sciences Tools & Services

The same industry, side by side on owner economics. Each figure is a through-cycle median, so a peak or trough year can’t distort it; the group median at the foot is the line to read each against.

Company	Revenue	Gross margin	Op. margin	ROIC	Owner earn. margin
EXASExact Sciences	$3.2B	70%	-36.6%	-13%	-13%
GHGuardant Health Inc.	$982M	61%	-101.3%	-30%	-62%
CDNACareDx Inc.	$380M	61%	-19.8%	-26%	-30%
BLLNBillionToOne Inc.	$305M	53%	-30.9%	—	-31%
MDXHMDxHealth SA	$108M	52%	-102.3%	-104%	-95%
Group median	—	61%	-36.6%	-28%	-31%

The price

What a price has to assume.

What the price implies

reverse-DCF

Enter the US price, in dollars: the NYSE/Nasdaq quote you hold. Per the filing's own cover, “American Depositary Shares (“ADS”), each representing 10 ordinary”; MDxHealth SA reports in USD, so every figure in this tool is stated per ADS so your dollar quote reconciles exactly. The record tables elsewhere on this page remain as filed.

MDxHealth SA is profitable, but owner earnings are negative this year because capital spending currently outruns operating cash, a build-out, so the owner-earnings reverse-DCF has no positive base to grow. We read the price from both ends instead: type a price to see the steady-state profitability it demands, then set the mature margin you would believe and weigh the two against each other. Nothing leaves your browser unless you enter it in your notebook.

Today’s price $

The assumptions Required return 9% Years to get there 10 Revenue growth 0%

Revenue, delivered48%/yr’20→’25

Mature owner-earnings margin 15%

Enter a price to run it.

Owner earnings it must reach—

Margin the price demands—

Owner-earnings margin today−3%

Two reads of one future. From your price: the owner earnings the company must reach, valued at a mature multiple and discounted back at your rate, expressed as the margin it implies on revenue grown at your rate. From your belief: the mature margin you would credit, set on the dial above. When the margin the price demands runs above the one you would believe, you are paying for a future taken on faith. For a deep cyclical at a trough, normalized through-cycle earnings are the better lens; this mode is for the genuinely unprofitable, and for the profitable business whose capital spending currently outruns its cash.

Weigh MDXH against another business →

Cite: Owner Scorecard, "MDxHealth SA (MDXH), the owner's record," https://ownerscorecard.com/c/MDXH, data as of 2026-07-09.

Manual order: ← MDWD its page in the Manual MEOH →

Industry order: ← MASS the Life Sciences Tools & Services chapter MEDP →