FXH vs XLV: Grades, Fees and Holdings Compared

First Trust Health Care AlphaDEX Fund

FXHBNYSE Arca

State Street Health Care Select Sector SPDR ETF

XLVANYSE Arca

Overlap

29.7%by weight

Expense ratio

XLV −0.53pt a year

FXH0.61%XLV0.08%

Avg volume · 30D

XLV 161.0×the volume

FXH56.5KXLV9.1M

10Y return · a year

XLV +2.8pt

FXH+9.7%XLV+12.5%

FXH vs XLV Performance

Oct 29, 2021 – Oct 30, 2026

+16.1%FXH+49.8%XLV

Expense ratio: FXH 0.61%; XLV 0.08%, better
Fund size: FXH $1.16B; XLV $48.5B
1Y total return: FXH +24.1%; XLV +30.3%, better
Yield (12M): FXH 0.54%; XLV 1.38%, better
Holdings: FXH 73; XLV 64
Avg volume (30D): FXH 56.5K sh; XLV 9.1M sh, better
NAV per share: FXH $137.20; XLV $184.09
52W range

ETF.net Grade

Pillar letters and Scores for FXH, XLV, with each pillar’s weight
Pillar	FXH	XLV
Cost30% weight	D33	A98Higher
Mission25% weight	Not scored	A84
Risk15% weight	A70	A78Higher
Tradability15% weight	A78	A100Higher
Holdings10% weight	A82Higher	D39
Durability5% weight	B67	A87Higher

Rank among Health Care (Broad) funds

How we build Categories ›

Same Category. FXH and XLV are both graded against the same 25 Health Care (Broad) funds, so their Grades compare head to head.

Health Care (Broad)⁠

Category · 25 funds

See all 25 ›

XLV ranks 1st and FXH 10th of 25 funds in the Health Care (Broad) Category.

Rank 1AXLVState Street Health Care Select Sector SPDR ETFScore 85
Rank 2AFHLCFidelity MSCI Health Care Index ETFScore 83
Rank 9BXHEState Street SPDR S&P Health Care Equipment ETFScore 64
Rank 10BFXHFirst Trust Health Care AlphaDEX FundScore 58
Rank 11BIHFiShares U.S. Healthcare Providers ETFScore 56

Our read on each fund

ETF.net Research

FXHBFirst Trust Health Care AlphaDEX Fund

XLVAState Street Health Care Select Sector SPDR ETF

In short

FXH A 2007-vintage twist on health care: instead of owning the whole sector, FXH runs Russell 1000 health care names through First Trust's AlphaDEX growth-and-value screen and holds roughly 80 of them.

XLV Live since 1998, XLV is the original way to own health care: about 60 S&P 500 names, a 0.08% fee, and one of the busiest tickers in the sector. Big pharma and device makers, not small-cap biotech.

Stated mandate

FXH The fund seeks before-fee results generally corresponding to the price and yield of the StrataQuant® Health Care Index. That index uses the AlphaDEX® methodology to select and weight health care stocks from the Russell 1000® Index.

XLV The fund seeks to track, before expenses, the price and yield performance of the Health Care Select Sector Index, which represents the health care sector of the S&P 500 Index.

Why people hold it

FXH AlphaDEX selects and weights health care stocks from the Russell 1000 using growth and value marks. A published rules screen, not a manager's hunch.ftportfolios.com
Live since 2007 and now a multi-billion-dollar fund. This is a long-running strategy with a real record, not a recent launch chasing a theme.
A focused book of about 80 stocks, so the screen's picks actually show up in results rather than getting diluted across the full sector. Pays quarterly.

XLV 0.08% a year against a cohort median of 0.50%. That ties it with FHLC as the cheapest in the group and edges VHT at 0.09%.
One of the most actively traded funds in its category, which generally keeps bid-ask spreads thin whether you trade 10 shares or 10,000.
Launched December 1998 as one of the first US sector funds, and it has tracked its S&P 500 health care index closely ever since.
Covers the whole sector in one line: pharma, devices, providers, biotech, life-science tools and health tech. Pays quarterly.ssga.com

Worth knowing

FXH The 0.61% fee runs near double the typical multifactor fund's. Cheap core peers like IUSG and VONV charge a small fraction of it.
Thinly traded for its size, so spreads can widen and fills on a market order may land away from the fund's underlying value.
Fee load and volatility profile leave it in the bottom quartile of its multifactor peer group, a group topped by broad, low-cost core funds.

XLV Cap-weighted and about 60 names deep, so the largest drug and device makers carry most of the weight.ssga.com
S&P 500 members only. Mid- and small-cap health care names sit outside the mandate.
One sector, one set of headlines: drug pricing rules, patent expirations and policy shifts move the whole basket together.

Full FXH profile⁠

Full XLV profile⁠

FXH vs XLV Holdings

How FXH and XLV differ

Overlap by weight

29.7%

Shared holdings make up 80.4% of XLV and 58.3% of FXH.

Level by level

Holdings43 in both29.7%
Asset classEquity100%
Countryby domicile100%
Sector2 Sectors99.7%

Sector

Sector weights in FXH and XLV, widest gap first
Sector	More in FXHMore in XLV	FXH	XLV
Health Care	FXH +0.2 points	99.5%	99.3%
Technology	XLV +0.2 points	0.5%	0.7%

Country, concentration and asset class

Country by domicile

Country weights in FXH and XLV, widest gap first
Country	More in FXHMore in XLV	FXH	XLV
United States	Same weight	100.0%	100.0%

Concentration

Weight in the 10 largest Holdings

FXH24.2%
XLV61.0%

Securities held

FXH72
XLV62

Asset class

FXH: Equity
XLV: Equity

Holdings

Only in FXH29
In both43
Only in XLV19

Only in FXH

29 securities, 41.5% of FXH by weight

Halozyme Therapeutics, Inc.2.68%
Caris Life Sciences, Inc.2.54%
Medpace Holdings, Inc.2.36%
Globus Medical, Inc. (Class A)2.36%
Guardant Health, Inc.2.27%
Natera, Inc.2.27%
Exelixis, Inc.2.15%
United Therapeutics Corporation2.00%
Tempus AI, Inc. (Class A)2.00%
Tenet Healthcare Corporation1.94%
Jazz Pharmaceuticals Plc1.69%
Corcept Therapeutics Inc.1.59%
Qiagen N.v.1.45%
Encompass Health Corporation1.42%
Ascendis Pharma A/S1.40%
Neurocrine Biosciences, Inc.1.31%
Revolution Medicines, Inc.1.18%
Doximity, Inc. (Class A)1.05%
BridgeBio Pharma, Inc.1.03%
Chemed Corporation0.96%
The Ensign Group, Inc.0.96%
Envista Holdings Corporation0.91%
Arrowhead Pharmaceuticals, Inc.0.83%
Madrigal Pharmaceuticals, Inc.0.77%
Axsome Therapeutics, Inc.0.71%
Elanco Animal Health Incorporated0.44%
Insmed Incorporated0.42%
Bio-Rad Laboratories, Inc. (Class A)0.42%
Medline Inc. (Class A)0.39%

Only in XLV

19 securities, 19.4% of XLV by weight

Merck & Co. Inc.5.41%
Gilead Sciences Inc3.08%
Cvs Health Corp1.73%
Mckesson Corp1.71%
Moderna Inc1.24%
Cencora Inc0.94%
Cardinal Health Inc0.87%
Edwards Lifesciences Corp0.82%
Waters Corp0.71%
Iqvia Holdings Inc0.68%
Illumina Inc0.66%
Mettler Toledo International0.52%
Revvity Inc0.28%
Charles River Laboratories0.27%
Baxter International Inc0.18%
Bio Techne Corp0.17%
Insulet Corp0.16%
Xav Health Care DEC260.02%
Contra Hologic Incorpo0.00%

Weight gaps

All 43 Holdings in both funds, largest gap first.

Holding weights in FXH and XLV, widest gap first
Holding	More in FXHMore in XLV	FXH	XLV
Eli Lilly and CompanyLLY	XLV +14.24 points	2.22%	16.46%
Johnson & JohnsonJNJ	XLV +9.49 points	0.44%	9.93%
AbbVie Inc.ABBV	XLV +6.27 points	1.43%	7.70%
UnitedHealth Group IncorporatedUNH	XLV +5.05 points	0.47%	5.52%
Thermo Fisher Scientific Inc.TMO	XLV +3.49 points	0.44%	3.93%
Universal Health Services, Inc. (Class B)UHS	FXH +2.15 points	2.29%	0.14%
Zimmer Biomet Holdings, Inc.ZBH	FXH +2.13 points	2.41%	0.28%
Centene CorporationCNC	FXH +1.98 points	2.49%	0.51%
Intuitive Surgical, Inc.ISRG	XLV +1.92 points	0.45%	2.37%
Solventum CorporationSOLV	FXH +1.91 points	2.09%	0.18%
Danaher CorporationDHR	XLV +1.78 points	0.44%	2.22%
Abbott LaboratoriesABT	XLV +1.74 points	0.97%	2.71%
The Cooper Companies, Inc.COO	FXH +1.73 points	1.91%	0.18%
Amgen Inc.AMGN	XLV +1.73 points	2.00%	3.73%
DexCom, Inc.DXCM	FXH +1.71 points	2.16%	0.45%
GE HealthCare Technologies Inc.GEHC	FXH +1.60 points	2.12%	0.52%
Pfizer Inc.PFE	XLV +1.59 points	0.97%	2.56%
Zoetis Inc.ZTS	FXH +1.59 points	2.07%	0.48%
Incyte CorporationINCY	FXH +1.50 points	1.80%	0.30%
The Cigna GroupCI	FXH +1.30 points	2.48%	1.18%
DaVita Inc.DVA	FXH +1.26 points	1.36%	0.10%
Stryker CorporationSYK	XLV +1.18 points	0.45%	1.63%
Align Technology, Inc.ALGN	FXH +1.16 points	1.31%	0.15%
Vertex Pharmaceuticals IncorporatedVRTX	XLV +1.08 points	0.97%	2.05%
Labcorp Holdings Inc.LH	FXH +1.04 points	1.49%	0.45%
Steris PlcSTE	FXH +1.03 points	1.37%	0.34%
Viatris Inc.VTRS	FXH +1.03 points	1.36%	0.33%
Regeneron Pharmaceuticals, Inc.REGN	FXH +1.02 points	2.22%	1.20%
Quest Diagnostics IncorporatedDGX	FXH +0.95 points	1.37%	0.42%
Boston Scientific CorporationBSX	FXH +0.81 points	1.74%	0.93%
Henry Schein, Inc.HSIC	FXH +0.80 points	0.92%	0.12%
ResMed Inc.RMD	FXH +0.77 points	1.32%	0.55%
Biogen Inc.BIIB	FXH +0.47 points	1.02%	0.55%
HCA Healthcare, Inc.HCA	FXH +0.36 points	1.41%	1.05%
Agilent Technologies, Inc.A	XLV +0.34 points	0.43%	0.77%
Humana Inc.HUM	XLV +0.29 points	0.46%	0.75%
IDEXX Laboratories, Inc.IDXX	XLV +0.23 points	0.45%	0.68%
Veeva Systems Inc. (Class A)VEEV	XLV +0.23 points	0.46%	0.69%
Becton, Dickinson and CompanyBDX	FXH +0.19 points	1.00%	0.81%
Medtronic PlcMDT	FXH +0.16 points	1.94%	1.78%
Bristol-Myers Squibb CompanyBMY	XLV +0.07 points	1.81%	1.88%
West Pharmaceutical Services, Inc.WST	FXH +0.03 points	0.47%	0.44%
Elevance Health Inc.ELV	Same weight	1.37%	1.37%

All 72 FXH holdings⁠All 61 XLV holdings⁠

How we measure overlap

Each holding counts at its smaller weight in the two funds, summed over the full Holdings. Sector, country and asset class use the same rule on each fund’s split. Cash, FX and derivative lines stay out of the counts. Two bond funds get no overlap figure.

FXH vs XLV Cost

Overpaying FXH vs XLV

$10,309

On $10,000 over 30 years. 7% growth a year before fees, expense ratio only.

FXH 0.61%
$11,998
XLV 0.08%
$1,689

Amount$10,000

Years30 years

Cost over time

FXH 0.61%
XLV 0.08%
Overpaying

Year by year

Year	FXH	XLV	Overpaying
10	$1,093	$147	$946
20	$4,181	$575	$3,606
30	$11,998	$1,689	$10,309

Expense ratio

0.61%FXH
0.08%XLV, cheaper

XLV0.08%FXH0.61%

0.08%0.85%

Middle half of Health Care (Broad) funds
Median 0.50%

XLV cheapest of 25 funds

FXH 17th cheapest of 25 funds

FXH vs XLV Dividends

Last 12 months to Oct 30, 2026

Yield (12M): FXH 0.54%; XLV 1.38%, better
Payout (12M): FXH $0.74; XLV $2.55
Last payment: FXH $0.29; XLV $0.64
Ex-dividend: FXH Sep 24, 2026; XLV Sep 21, 2026
Paid on: FXH Sep 30, 2026; XLV Sep 23, 2026
Frequency: FXH Quarterly; XLV Quarterly

Distribution history

Per share, 2017 to 2026, same scale for both

FXHQuarterly · 17 paymentsAll FXH payments⁠

XLVQuarterly · 40 paymentsAll XLV payments⁠

FXH vs XLV Risk

Fall from peak · 5 years

Risk facts

VolatilityStd dev, 3 years: FXH 14.3%, betterXLV 14.8%
Return per unit of riskSharpe ratio, 3 years: FXH 0.78XLV 0.78
Worst fallMax drawdown, 5 years: FXH −27.6%XLV −17.1%, better
Market sensitivityBeta, 5 years: FXH 0.72XLV 0.56; Market = 1

FXH and XLV in the news

All news⁠

Deep Dive
Eli Lilly is 15% of the biggest health care ETF
Sep 25, 2026FXHXLV
The Big Picture
Two-year Treasury yield fell 11 basis points alongside the AI share selloff
Oct 31, 2026XLV
Top Movers
Alphabet fell 12.6%, but the average stock rose
Oct 29, 2026XLV
Closing Bell
Alphabet falls 12.6% - dragging SPY into negative territory for the day
Oct 29, 2026XLV
Deep Dive
Moderna fell 18% on cancer-vaccine data, and genomics ETFs fell 4%
Oct 23, 2026XLV
Opening Bell
Nasdaq futures rise as SpaceX posts its first public profit
Oct 21, 2026XLV

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