MEDX vs. XLV

Last updated Jun 4, 2026

MEDX (Horizon Kinetics Medical ETF) and XLV (State Street Health Care Select Sector SPDR ETF) are both Health & Biotech Equities funds. MEDX is actively managed, while XLV is passively managed. Over the past 3 years, MEDX returned 5.77%/yr vs 5.98%/yr for XLV. A 0.79 correlation means they provide meaningful diversification when combined. MEDX charges 0.85%/yr vs 0.08%/yr for XLV.

Performance

MEDX vs. XLV - Performance Comparison

The chart below illustrates the hypothetical performance of a $10,000 investment in Horizon Kinetics Medical ETF (MEDX) and State Street Health Care Select Sector SPDR ETF (XLV). The values are adjusted to include any dividend payments, if applicable.

Returns By Period

In the year-to-date period, MEDX achieves a 0.84% return, which is significantly higher than XLV's -4.29% return.

MEDX

• 1D: 0.92%
• 1M: 2.85%
• YTD: 0.84%
• 6M: 0.03%
• 1Y: 29.45%
• 3Y*: 5.77%
• 5Y*: —
• 10Y*: —

XLV

• 1D: 0.79%
• 1M: 1.95%
• YTD: -4.29%
• 6M: -4.06%
• 1Y: 12.89%
• 3Y*: 5.98%
• 5Y*: 5.55%
• 10Y*: 9.20%

*Multi-year figures are annualized to reflect compound growth (CAGR)

MEDX vs. XLV - Yearly Performance Comparison

	2026 (YTD)	2025	2024	2023
MEDX Horizon Kinetics Medical ETF	0.84%	28.62%	-4.68%	-6.22%
XLV State Street Health Care Select Sector SPDR ETF	-4.29%	14.50%	2.47%	3.97%

Correlation

The correlation between MEDX and XLV is 0.83, indicating a strong positive relationship between their price movements. Combining them offers limited diversification - they tend to fall together during downturns.

	Correlation
Correlation (1Y) Calculated over the trailing 1-year period	0.83
Correlation (3Y) Calculated over the trailing 3-year period	0.79
Correlation (All Time) Calculated using the full available price history since Feb 1, 2023	0.79

The correlation between MEDX and XLV has been stable across timeframes, ranging from 0.79 to 0.83 - a consistent structural relationship.

MEDX vs. XLV - Sectors Allocation Comparison

Sectors	MEDX	XLV
Healthcare	100.0%	100.0%
Basic Materials	-	-
Communication Services	-	-
Consumer Cyclical	-	-
Consumer Defensive	-	-
Energy	-	-
Financial Services	-	-
Industrials	-	-
Real Estate	-	-
Technology	-	-
Utilities	-	-

Return for Risk

MEDX vs. XLV — Risk / Return Rank

Compare risk-adjusted metric ranks to identify better-performing investments over the past 12 months.

MEDX

MEDX Risk / Return Rank: 50
MEDX Sharpe Ratio Rank: 48
MEDX Sortino Ratio Rank: 53
MEDX Omega Ratio Rank: 45
MEDX Calmar Ratio Rank: 57
MEDX Martin Ratio Rank: 47

XLV

XLV Risk / Return Rank: 24
XLV Sharpe Ratio Rank: 24
XLV Sortino Ratio Rank: 26
XLV Omega Ratio Rank: 23
XLV Calmar Ratio Rank: 26
XLV Martin Ratio Rank: 23

The rank (0–100) shows how this investment's returns compare to the risk taken. Higher = better. Based on the past 12 months of data, combining Sharpe, Sortino, and other metrics used by quantitative funds and institutional investors.

MEDX vs. XLV - Risk-Adjusted Trends Comparison

This table presents a comparison of risk-adjusted performance metrics for Horizon Kinetics Medical ETF (MEDX) and State Street Health Care Select Sector SPDR ETF (XLV). Risk-adjusted metrics are performance indicators that assess an investment's returns in relation to its risk, enabling a more accurate comparison of different investment options.

	MEDX	XLV	Difference
Sharpe ratio Return per unit of total volatility	1.65	0.88	+0.77
Sortino ratio Return per unit of downside risk	2.57	1.42	+1.15
Omega ratio Gain probability vs. loss probability	1.29	1.16	+0.13
Calmar ratio Return relative to maximum drawdown	2.81	1.24	+1.57
Martin ratio Return relative to average drawdown	7.81	2.99	+4.82
Data is calculated on a 1-year rolling basis and updated daily. The trend shows the change in the indicator over the past month.

MEDX vs. XLV - Sharpe Ratio Comparison

The current MEDX Sharpe Ratio is 1.65, which is higher than the XLV Sharpe Ratio of 0.88. The chart below compares the historical Sharpe Ratios of MEDX and XLV, calculated using daily returns over the previous 12 months. A higher Sharpe Ratio indicates better risk-adjusted performance relative to the risk-free rate.

Sharpe Ratios by Period

	MEDX	XLV	Difference
Sharpe Ratio (1Y) Calculated over the trailing 1-year period	1.65	0.88	+0.77
Sharpe Ratio (5Y) Calculated over the trailing 5-year period	—	0.38	—
Sharpe Ratio (10Y) Calculated over the trailing 10-year period	—	0.56	—
Sharpe Ratio (All Time) Calculated using the full available price history	0.27	0.46	-0.19

Drawdowns

MEDX vs. XLV - Drawdown Comparison

The maximum MEDX drawdown since its inception was -23.10%, smaller than the maximum XLV drawdown of -39.17%. Use the drawdown chart below to compare losses from any high point for MEDX and XLV.

Drawdown Indicators

	MEDX	XLV	Difference
Max Drawdown Largest peak-to-trough decline	-23.10%	-39.17%	+16.07%
Max Drawdown (1Y) Largest decline over 1 year	-10.54%	-10.47%	-0.07%
Max Drawdown (3Y) Largest decline over 3 years	-23.10%	-17.11%	-5.99%
Max Drawdown (5Y) Largest decline over 5 years	—	-17.11%	—
Max Drawdown (10Y) Largest decline over 10 years	—	-28.40%	—
Current Drawdown Current decline from peak	-5.55%	-7.52%	+1.97%
Average Drawdown Average peak-to-trough decline	-6.72%	-7.12%	+0.40%
Ulcer Index Depth and duration of drawdowns from previous peaks	3.78%	4.32%	-0.54%

Volatility

MEDX vs. XLV - Volatility Comparison

Horizon Kinetics Medical ETF (MEDX) has a higher volatility of 4.92% compared to State Street Health Care Select Sector SPDR ETF (XLV) at 4.10%. This indicates that MEDX's price experiences larger fluctuations and is considered to be riskier than XLV based on this measure. The chart below showcases a comparison of their rolling one-month volatility.

Volatility by Period

	MEDX	XLV	Difference
Volatility (1M) Calculated over the trailing 1-month period	4.92%	4.10%	+0.82%
Volatility (6M) Calculated over the trailing 6-month period	13.08%	10.24%	+2.84%
Volatility (1Y) Calculated over the trailing 1-year period	17.88%	14.67%	+3.21%
Volatility (5Y) Calculated over the trailing 5-year period, annualized	16.97%	14.69%	+2.28%
Volatility (10Y) Calculated over the trailing 10-year period, annualized	16.97%	16.55%	+0.42%

MEDX vs. XLV - Expense Ratio Comparison

MEDX has a 0.85% expense ratio, which is higher than XLV's 0.08% expense ratio.

Dividends

MEDX vs. XLV - Dividend Comparison

MEDX's dividend yield for the trailing twelve months is around 1.22%, less than XLV's 1.70% yield.

Position	TTM	2025	2024	2023	2022	2021	2020	2019	2018	2017	2016	2015
MEDX Horizon Kinetics Medical ETF	1.22%	1.23%	1.92%	4.94%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%	0.00%
XLV State Street Health Care Select Sector SPDR ETF	1.70%	1.60%	1.67%	1.59%	1.47%	1.33%	1.49%	2.17%	1.57%	1.47%	1.60%	1.43%

Frequently Asked Questions

Can I hold both MEDX and XLV in my portfolio?

MEDX and XLV have a correlation of 0.83, meaning they provide meaningful diversification benefit when combined. Depending on your allocation goals, holding both could reduce overall portfolio risk.

Which is riskier, MEDX or XLV?

MEDX has higher volatility (4.92%) compared to XLV (4.10%). In terms of maximum drawdown, MEDX dropped -23.10% vs XLV's -39.17%.

Which ETF is better, MEDX or XLV?

On 3-year performance, XLV leads with 5.98% vs 5.77% for MEDX. On fees, XLV is cheaper at 0.08% per year. On volatility, XLV has been the lower-risk option at 4.10%. The better choice depends on whether you care most about return, fees, risk, or income.

Which ETF has performed better, MEDX or XLV?

Over the 3-year period, XLV has performed better with a 5.98% return vs 5.77%. Past performance does not guarantee future results, so compare this with risk, fees, and fund exposure.

Which ETF is cheaper, MEDX or XLV?

XLV is cheaper with a 0.08% expense ratio, compared with 0.85% for MEDX.

Which ETF pays a higher dividend yield, MEDX or XLV?

XLV has the higher dividend yield at 1.70%, compared with 1.22% for MEDX.

What is the main difference between MEDX and XLV?

They also come from different issuers: Horizon and State Street. Their fees differ too: 0.85% for MEDX and 0.08% for XLV.

Which has better risk-adjusted returns?

MEDX currently has the higher Sharpe Ratio (1.65 vs 0.88), meaning it's delivered slightly more return per unit of risk over the trailing 12 months. However, this ranking shifts over time - use the Risk/Return Score above for a more comprehensive view that combines Sharpe, Sortino, and other measures used by quantitative funds.