At a glance
FXH charges 0.61% a year, above the 0.31% average of the 8 funds most like it (the most expensive of 9). It has $1.05B in assets, the 8th largest of that group; it paid 0.55% of its price in distributions over the past 12 months, quarterly. Over the past year it returned +19.7% with distributions reinvested (S&P 500: +11.5%), 8th of those 9 funds; over three years it returned +15.1% a year. At its worst it fell 30.6% in the 2020 crash (S&P 500: 33.7%) and 21.2% in the 2022 bear market (S&P 500: 24.5%), and was back at its earlier high 2 months and 45 months after the lows. Its ten largest positions make up 24.6% of the fund, out of 74 in all.
The short version
First Trust Health Care AlphaDEX Fund (FXH) is an ETF that tracks the StrataQuant Health Care Index. The index picks U.S. health care stocks from the Russell 1000 by scoring them on growth and value, not by company size. Holdings are weighted close to equally, so the 10 largest made up about 25% of assets as of July 31, 2026. The trade-off is cost: its 0.61% expense ratio is about double the 0.31% average for similar funds.
Price history
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FXH +19.7% over the year to Oct 27, 2026, total return with distributions reinvested.
How it has behaved
| YTD | 1 yr | 3 yr | 5 yr | 10 yr | Since start | |
|---|---|---|---|---|---|---|
| FXH official prospectus, to Dec 31, 2024 | — | +1.10% | — | +4.53% | +5.72% | +9.90% |
| FXH price data to Oct 27, 2026 | +19.2% | +19.7% | +15.1% | +3.1% | +9.4% | +10.5% |
- Over the year to Oct 27, 2026, FXH returned +19.7%, 8th of 9 among similar funds.
- Its 5-year annualized return was +3.1% and its 10-year +9.4%.
- In the 2020 COVID crash it fell 30.6% and regained its old high 2.2 months after the low.
- Its worst full calendar year was 2008 (-29.5%); its best was 2009 (+51.2%).
- The deepest fall in its price history was 43.7% (Oct 10, 2007 to Nov 20, 2008), recovered by Dec 14, 2009.
Show as a table
| Year | Price data | Prospectus (official) |
|---|---|---|
| 2026 (to date) | +19.1% | — |
| 2025 | +10.2% | — |
| 2024 | +1.0% | +1.10% |
| 2023 | -4.5% | -4.50% |
| 2022 | -12.2% | -12.21% |
| 2021 | +15.2% | +15.18% |
| 2020 | +28.0% | +27.85% |
| 2019 | +22.3% | +22.31% |
| 2018 | -1.3% | -1.26% |
| 2017 | +21.8% | +21.78% |
| 2016 | -5.2% | -5.20% |
| 2015 | +0.3% | +0.23% |
| 2014 | +25.4% | — |
| 2013 | +47.6% | — |
| 2012 | +20.6% | — |
| 2011 | +5.7% | — |
| 2010 | +19.0% | — |
| 2009 | +51.2% | — |
| 2008 | -29.5% | — |
| 2008 financial crisis stocks fell Oct 9, 2007 – Mar 9, 2009 | Lost 41.1% over that stretch · deepest drop along the way 43.7%, back to its old high 12.8 months after the low |
|---|---|
| 2020 COVID crash stocks fell Feb 19, 2020 – Mar 23, 2020 | Lost 30.6% over that stretch · deepest drop along the way 30.6%, back to its old high 2.2 months after the low |
| 2022 bear market stocks fell Jan 3, 2022 – Oct 12, 2022 | Lost 20.6% over that stretch · deepest drop along the way 21.2%, back to its old high 44.9 months after the low |
Dividends and income
Show as a table
| Year | Per share | Change |
|---|---|---|
| 2026 (to date) | $0.6000 | |
| 2025 | $0.8500 | +93.2% |
| 2024 | $0.4400 | +83.3% |
| 2023 | $0.2400 | +9.1% |
| 2022 | $0.2200 | +4300.0% |
| 2013 | $0.0050 | -96.5% |
| 2012 | $0.1410 | +340.6% |
| 2011 | $0.0320 | +10.3% |
| 2010 | $0.0290 |
What's inside
As of Jul 31, 2026, the fund held 74 securities; the ten largest made up 24.63% of assets.
| Holding | Weight | |
|---|---|---|
| REGENERON PHARMACEUTICALS INC | 2.77% | |
| UNIVERSAL HEALTH SERVICES INC | 2.57% | |
| SOLVENTUM CORP | 2.51% | |
| BOSTON SCIENTIFIC CORP | 2.48% | |
| ZIMMER BIOMET HOLDINGS INC | 2.47% | |
| GUARDANT HEALTH INC | 2.45% | |
| DAVITA INC | 2.44% | |
| PFIZER INC | 2.35% | |
| TENET HEALTHCARE CORP | 2.30% | |
| CIGNA GROUP (THE) | 2.29% | |
| GLOBUS MEDICAL INC | 2.26% | |
| MEDLINE INC | 2.26% | |
| NATERA INC | 2.23% | |
| CORCEPT THERAPEUTICS INC | 2.23% | |
| CENTENE CORP | 2.20% |
By country
United States 93.17%Ireland 3.32%Netherlands 1.79%Denmark 1.55%By asset type
Stocks 99.82%RA 0.01%What changed recently
- Over the three months to Jul 31, 2026, investors added a net $62.3M (creations minus redemptions, per the N-PORT report).
- Monthly total returns reported for that quarter: +1.96%, +6.33%, +3.96%.
How it works
FXH normally puts at least 90% of its assets into the stocks in the StrataQuant Health Care Index, which is built by ICE Data Indices. The index starts with Russell 1000 stocks that pass share-class and liquidity screens. It ranks each stock on growth and value factors. A growth stock gets its growth rank, a value stock gets its value rank, and a blend stock gets the better of the two. This method, called AlphaDEX, tries to find stocks that may earn "alpha," meaning better returns than a standard index after adjusting for risk.
The health care stocks are then ranked by score. The index keeps the top 75% or 40 stocks, whichever number is larger. Those stocks are split into five groups, and higher-scoring groups get more weight. As of October 31, 2025, the index held 76 stocks worth $1.75 billion to $455.04 billion each. As of July 31, 2026, the fund held 74 holdings. The largest was Regeneron Pharmaceuticals, at just 2.77%.
The index is rebuilt and rebalanced every quarter, and the fund follows soon after. That pushed portfolio turnover (the share of holdings replaced in a year) to 85%. Trading costs from that turnover are not part of the expense ratio. The fund owns ordinary stocks and held no derivatives as of July 31, 2026.
What it really costs
- FXH charges 0.61% a year, versus an average of 0.31% for the similar funds below (9th of 9, cheapest first).
- Of that, 0.5% is the management fee; the rest covers other fund expenses.
In a retirement portfolio
FXH holds a single sector, chooses stocks by factor scores, and costs more than most health care funds, so it fits better as a small add-on than as a foundation.
FXH could add health care exposure with a different mix of companies than size-weighted sector funds. Its record in downturns varies. In the 2008 financial crisis it fell 43.7%, its deepest drop, and regained its peak in about 13 months, by December 2009. Its worst calendar year was 2008, at -29.5%. In the 2020 COVID crash it fell 30.6% and recovered in about two months. The 2022 drop of 21.2% lasted much longer: the fund did not regain its January 2022 peak until June 25, 2026, nearly 45 months later. Anyone forced to sell in that stretch would have locked in losses. Income is small. The trailing 12-month yield was 0.55% as of October 27, 2026, paid quarterly. The 0.61% expense ratio is well above the 0.31% peer average. Past results don't predict future ones, and a plan should look at the whole portfolio, not one fund.
Who it may suit — and who should look elsewhere
May suit
- Investors who want health care exposure where mid-sized firms like Universal Health Services and DaVita carry about as much weight as Pfizer.
- People comfortable with a rules-based index that scores stocks on growth and value and reshuffles them quarterly, with 85% annual turnover.
- Holders keeping it as a small slice who can live through single-sector slumps, like the 2022 drop that took nearly 45 months to recover.
Look elsewhere if
- Cost-focused investors: FXH charges 0.61%, compared with 0.09% for Vanguard Health Care ETF (VHT) and 0.08% for XLV.
- Anyone counting on meaningful income, since the trailing 12-month yield was only 0.55% as of October 27, 2026.
- Investors looking for one fund spread across many sectors; FXH holds only about 74 health care stocks, 93% of them U.S.-listed.
Close alternatives
Matched by holdings overlap from the latest N-PORT reports.
| Fund | Overlap | Cost | Net assets | 1 yr | 3 yr |
|---|---|---|---|---|---|
| FXH this fund | — | 0.61% | $1.05B | +19.7% | +15.1% |
| RSPH Invesco S&P 500 Equal Weight Health Care ETF | 51% | 0.4% | $766.9M | +28.4% | +16.6% |
| IYH iShares U.S. Healthcare ETF | 37% | 0.39% | $3.56B | +23.8% | +15.0% |
| VHT Vanguard Health Care ETF | 34% | 0.09% | $22.04B | +28.9% | +16.9% |
| FHLC Fidelity MSCI Health Care Index ETF | 33% | 0.084% | $3.29B | +23.8% | +16.0% |
| XLV Health Care Select Sector SPDR Fund | 30% | 0.08% | $40.60B | +30.2% | +16.2% |
| IXJ iShares Global Healthcare ETF | 25% | 0.41% | $3.84B | +19.5% | +13.4% |
| IBB iShares Biotechnology ETF | 25% | 0.45% | $9.09B | +35.3% | +23.9% |
Questions investors ask
Is FXH good for retirement?
FXH can work as a small satellite position, but it is not built to be a core holding. It owns only health care stocks, pays little income (a 0.55% trailing yield as of October 27, 2026) and charges 0.61% a year. Its 2022 drop of 21.2% took until June 2026 to recover, nearly 45 months. That slow recovery and narrow focus are worth weighing for anyone who may need to sell shares in a bad year.
What's the difference between FXH and RSPH?
Both spread money fairly evenly across health care stocks, and about 51% of their holdings overlap. Invesco S&P 500 Equal Weight Health Care ETF (RSPH) gives equal weight to S&P 500 health care stocks and charges 0.40%. FXH scores Russell 1000 health care stocks on growth and value, drops the weakest scorers, tilts toward the highest and charges 0.61%. Through October 27, 2026, RSPH returned 28.4% over one year versus 19.7% for FXH. Over three years, RSPH returned 16.6% a year versus 15.1%.
Does FXH pay dividends?
Yes, FXH pays dividends every quarter, but the amounts are small. Over the 12 months through October 27, 2026, it paid $0.74 per share, a trailing yield of 0.55%. Many health care companies pay modest dividends or none, and the fund's selection method looks for growth and value traits, not income. Investors who want steady cash flow from their holdings would likely find the payout too small to matter much.
What is FXH's expense ratio?
FXH's expense ratio is 0.61% a year, according to its prospectus filed November 28, 2025. That includes a 0.50% management fee, with no fee waiver. It is the most expensive of the nine similar health care funds compared here, where the average is 0.31%. Large index funds cost far less: Vanguard Health Care ETF (VHT) charges 0.09%, Fidelity MSCI Health Care Index ETF (FHLC) 0.084%, and Health Care Select Sector SPDR Fund (XLV) 0.08%.
How has FXH performed over the last 10 years?
FXH's 10-year record has been moderate. Its prospectus shows an average annual return of 5.72% for the 10 years ending December 31, 2024, and 4.53% for five years. Based on share prices through October 27, 2026, the 10-year figure was 9.4% a year, but the five-year figure was only 3.1%. The fund lost 12.21% in 2022 and 4.5% in 2023, then gained 10.17% in 2025. It also ranked 8th of 9 similar funds on one-year return.