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First Trust AlphaDEX U.S. Health Care Sector Index ETF (FHH) and BMO SPDR Health Care Select Sector Index ETF (ZXLV.F) offer distinct profiles for Canadian ETF investors. A direct comparison shows that FHH focuses its top 3 sector exposures on Healthcare, while ZXLV.F leans towards Healthcare and Consumer Non-Cyclicals. When evaluating costs, FHH features a management fee (MER) of 0.7%, compared to 0.21% for ZXLV.F. Performance-wise, FHH has returned 20.1% year-to-date with -$2 M in net flows, whereas ZXLV.F is at 12.72% with +$13 M. Use the comparison tool below to benchmark these funds across top 10 holdings, yield, sector weights and historical returns.
NAV Performance and Flows
Key Data
Compare
FHH
ZXLV.F
| AuM | $5.03 M | $16.48 M |
| Management Fees | 0.70% | 0.21% |
| Exp. ratio | 0.76% | 0.21% |
| Tracking Difference | -1.08% | - |
Historical performance and flows
As of October 19, 2026
| 1M | 3M | YTD | 1Y | 3Y | ||
|---|---|---|---|---|---|---|
| Perf. | FHH | +1.88% | +9.11% | +20.10% | +18.05% | +45.41% |
ZXLV.F | +3.73% | +10.02% | +12.72% | +20.43% | - | |
| Flows | FHH | +$0 M | +$0 M | -$2 M | -$4 M | -$8 M |
ZXLV.F | +$3 M | +$9 M | +$13 M | +$14 M | - |
FHH vs ZXLV.F exposure
Countries
FHH
USA
93.13%
ZXLV.F
USA
97.52%
Sectors
FHH
Healthcare
98.23%
ZXLV.F
Healthcare
97.84%
As of October 19, 2026
Top 10 Holdings
FHH
Regeneron Pharmaceuticals, Inc.
2.86%
Pfizer Inc.
2.56%
Natera, Inc.
2.55%
Solventum Corp.
2.55%
Zimmer Biomet Holdings, Inc.
2.49%
Universal Health Services, Inc.
2.48%
Boston Scientific Corp.
2.43%
Guardant Health, Inc.
2.37%
Tenet Healthcare Corp.
2.29%
Halozyme Therapeutics, Inc.
2.22%
ZXLV.F
Eli Lilly & Co.
14.88%
Johnson & Johnson
10.41%
AbbVie, Inc.
7.37%
Merck & Co., Inc.
5.93%
UnitedHealth Group, Inc.
5.75%
Amgen, Inc.
3.77%
Thermo Fisher Scientific, Inc.
3.73%
Abbott Laboratories
3.13%
Gilead Sciences, Inc.
2.95%
Pfizer Inc.
2.64%
Diversification
FHH
Total weight of top 10 holdings out of 72 total
24.80%
ZXLV.F
Total weight of top 10 holdings out of 59 total
60.55%
Characteristics
Compare
FHH
ZXLV.F
| Provider | First Trust | BMO |
| Management | Passively managed | Passively managed |
| Benchmark | StrataQuant Health Care CAD Total Return Index - CAD | S&P Health Care Select Sector Total Return Index - USD |
| Replication Method | Direct (Physical) | Other |
| Asset Class | Equity | Equity |
| Dividend Policy | Distributing | Distributing |
| Trailing 12m distribution yield | 0.48% | 1.96% |
| Meets ESG criteria | No | No |
| Inception Date | October 30, 2014 | February 2, 2025 |
Frequently asked questions about FHH and ZXLV.F
Which ETF has performed better year to date: FHH or ZXLV.F?
As of October 19, 2026, FHH has returned 20.10% year to date, while ZXLV.F has returned 12.72%. FHH is ahead on YTD performance.
Which ETF is larger by assets under management: FHH or ZXLV.F?
As of October 19, 2026, FHH manages $5.03 M in assets, while ZXLV.F manages $16.48 M. ZXLV.F is the larger fund by AUM.
How are FHH and ZXLV.F managed?
FHH is passively managed by First Trust. It tracks the StrataQuant Health Care CAD Total Return Index - CAD benchmark. ZXLV.F is passively managed by BMO. It tracks the S&P Health Care Select Sector Total Return Index - USD benchmark.
What sectors do FHH and ZXLV.F emphasize?
FHH is most exposed to Healthcare. ZXLV.F is most exposed to Healthcare and Consumer Non-Cyclicals.
Which ETF is attracting more investor flows: FHH or ZXLV.F?
Year to date, FHH has seen -$2.10 M in net flows, compared with +$12.72 M for ZXLV.F. ZXLV.F has attracted more net investor money so far.
How do the fees of FHH and ZXLV.F compare?
FHH has an expense ratio of 0.76%, while ZXLV.F has an expense ratio of 0.21%.
What are the top holdings of FHH and ZXLV.F?
FHH's largest holdings include Regeneron Pharmaceuticals, Inc., Pfizer Inc., and Natera, Inc.. ZXLV.F's top holdings include Eli Lilly & Co., Johnson & Johnson, and AbbVie, Inc..
Which ETF is more diversified: FHH or ZXLV.F?
FHH holds 72 securities, while ZXLV.F holds 59. On holdings count, FHH is the more diversified portfolio.
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