State Street Health Care Select Sector SPDR ETF (XLV) belongs to the Health & Biotech Equities category. Below you'll find alternative ETFs from the same category, ranked by key criteria, plus funds that investors commonly compare with XLV. Use the tables to find lower-cost options, better risk-adjusted returns, or a closer substitute for your current allocation.
Cheapest Alternatives to XLV
XLV charges 0.08% annually. No ETFs in the Health & Biotech Equities category have lower expense ratios; the lowest-cost alternatives shown here go as low as 0.08%.
| Symbol | Name | Expense Ratio | AUM | Inception | |
|---|---|---|---|---|---|
| Fidelity MSCI Health Care Index ETF | 0.08% | 3.22B | Oct 2013 | XLV vs FHLC | |
| Vanguard Health Care ETF | 0.09% | 19.00B | Jan 2004 | XLV vs VHT | |
| Portfolio Building Block World Pharma and Biotech ... | 0.13% | 951.16M | Nov 2025 | XLV vs PBPH | |
| GSK plc ADRhedged ETF | 0.19% | 793.18K | Jan 2025 | XLV vs GSKH | |
| Invesco Nasdaq Biotechnology ETF | 0.19% | 74.65M | Jun 2021 | XLV vs IBBQ |
Best Risk-Adjusted Alternatives to XLV
XLV has a PortfoliosLab risk / return rank of 50. There are 36 ETFs in the Health & Biotech Equities category with higher risk-adjusted ranks, going as high as 96.
| Symbol | Name | Risk / Return Rank | AUM | Inception | |
|---|---|---|---|---|---|
| Virtus LifeSci Biotech Clinical Trials ETF | 96 | 57.56M | Dec 2014 | XLV vs BBC | |
| ALPS Medical Breakthroughs ETF | 94 | 213.08M | Dec 2014 | XLV vs SBIO | |
| First Trust Nasdaq Pharmaceuticals ETF | 94 | 36.36M | Sep 2016 | XLV vs FTXH | |
| iShares U.S. Pharmaceuticals ETF | 93 | 1.34B | May 2006 | XLV vs IHE | |
| SPDR S&P Biotech ETF | 93 | 11.10B | Feb 2006 | XLV vs XBI |
Top Performing XLV Alternatives (YTD)
XLV is at 5.41% YTD. There are 43 ETFs in the Health & Biotech Equities category with higher YTD returns, going as high as 41.35%.
| Symbol | Name | YTD Return | AUM | Inception | |
|---|---|---|---|---|---|
| AdvisorShares Psychedelics ETF | 41.35% | 44.37M | Sep 2021 | XLV vs PSIL | |
| ARK Genomic Revolution Multi-Sector ETF | 38.38% | 1.31B | Oct 2014 | XLV vs ARKG | |
| Roundhill UNH WeeklyPay ETF | 31.46% | 6.01M | Dec 2025 | XLV vs UNHW | |
| Virtus LifeSci Biotech Clinical Trials ETF | 29.44% | 57.56M | Dec 2014 | XLV vs BBC | |
| SPDR S&P Health Care Services ETF | 26.76% | 204.10M | Sep 2011 | XLV vs XHS |
Lowest Volatility Alternatives to XLV
XLV has 15.88% 1-year volatility. There are 11 ETFs in the Health & Biotech Equities category with lower 1-year volatility, going as low as 0.00%.
| Symbol | Name | Volatility 1Y | AUM | Inception | |
|---|---|---|---|---|---|
| Loncar Cancer Immunotherapy ETF | 0.00% | 12.73M | Oct 2015 | XLV vs CNCR | |
| Amplify Treatments, Testing and Advancements ETF | 0.00% | 9.68M | Jun 2020 | XLV vs GERM | |
| Horizon Kinetics SPAC Active ETF | 8.62% | 10.11M | Jun 2007 | XLV vs SPAQ | |
| State Street Health Care Select Sector SPDR Premiu... | 11.06% | 16.78M | Jul 2025 | XLV vs XLVI | |
| Milliman Healthcare Inflation Plus ETF | 11.54% | 982.35K | Apr 2026 | XLV vs MHIP |
Lowest Drawdown Alternatives to XLV
XLV has a 1-year max drawdown of -10.47%. There are 14 ETFs in the Health & Biotech Equities category with shallower 1-year drawdowns, going as shallow as 0.00%.
| Symbol | Name | Max Drawdown 1Y | AUM | Inception | |
|---|---|---|---|---|---|
| Amplify Treatments, Testing and Advancements ETF | 0.00% | 9.68M | Jun 2020 | XLV vs GERM | |
| Horizon Kinetics SPAC Active ETF | -4.32% | 10.11M | Jun 2007 | XLV vs SPAQ | |
| First Trust Nasdaq Pharmaceuticals ETF | -7.47% | 36.36M | Sep 2016 | XLV vs FTXH | |
| Invesco Nasdaq Biotechnology ETF | -8.34% | 74.65M | Jun 2021 | XLV vs IBBQ | |
| iShares U.S. Pharmaceuticals ETF | -8.47% | 1.34B | May 2006 | XLV vs IHE |
Other ETFs from State Street
The 10 most viewed State Street ETFs shown here include SPY, GLD, XLK and span 10 categories. AUM among these funds goes as high as $783B.
| Symbol | Name | Category | Risk / Return Rank | YTD Return | AUM | Inception | |
|---|---|---|---|---|---|---|---|
| State Street SPDR S&P 500 ETF | S&P 500 | 65 | 10.67% | 783.21B | Jan 1993 | XLV vs SPY | |
| SPDR Gold Shares | Gold, Precious Metals | 21 | -7.91% | 132.10B | Nov 2004 | XLV vs GLD | |
| State Street Technology Select Sector SPDR ETF | Technology Equities | 54 | 23.60% | 120.59B | Dec 1998 | XLV vs XLK | |
| State Street SPDR Portfolio S&P 500 Growth ETF | S&P 500, Large Cap Growth Equities | 44 | 10.85% | 52.75B | Sep 2000 | XLV vs SPYG | |
| State Street SPDR Portfolio S&P 500 High Dividend ... | S&P 500, Dividend | 65 | 17.05% | 7.40B | Oct 2015 | XLV vs SPYD | |
| State Street Energy Select Sector SPDR ETF | Energy Equities | 59 | 29.29% | 36.33B | Dec 1998 | XLV vs XLE | |
| State Street SPDR Portfolio S&P 500 ETF | S&P 500 | 66 | 10.74% | 158.31B | Nov 2005 | XLV vs SPYM | |
| SPDR Gold MiniShares Trust | Gold, Precious Metals | 22 | -7.79% | 27.70B | Jun 2018 | XLV vs GLDM | |
| State Street Utilities Select Sector SPDR ETF | Utilities Equities | 31 | 7.94% | 23.51B | Dec 1998 | XLV vs XLU | |
| SPDR Bloomberg 1-3 Month T-Bill ETF | Government Bonds, Ultrashort Bond | 100 | 1.92% | 46.75B | May 2007 | XLV vs BIL |
Often Compared With XLV
Investors most often compare XLV with XLF, IXJ, VOO. These 20 comparison targets span 5 categories, based on PortfoliosLab usage data.
Compare XLV with Any Fund or Stock
Compare XLV with any ETF, mutual fund, or stock using PortfoliosLab's comparison tool.
Pair XLV with funds that move differently
State Street Health Care Select Sector SPDR ETF alternatives help with substitution. Diversifiers are the next step when you want funds with lower historical correlation to XLV.
Explore XLV Diversifiers