Statistics · 2026 · ETFs
Healthcare ETF Statistics (2026)
XBI was the best-performing health care ETF over the past year, returning 54.5% with dividends reinvested, as of October 2, 2026. IYH returned 21.2%. The S&P 500 fund SPY returned 16.7%. Each return runs from a month-end close to the October 2, 2026 price and is annualized over the actual days: the one-year figure covers September 30, 2025 to October 2, 2026, so it will not match an issuer's month-end one-year return. Biotech funds and broad health care funds behaved like two different products on risk, so the choice depends on which one you want.
Key takeaways
- XBI returned 54.5% over the past year and IYH returned 21.2%, a gap of 33.3 points.
- Over five years, 0 of the 6 health care funds beat SPY’s 13.9% a year, and the best returned 7.2%.
- Expense ratios run from 0.08% for XLV to 0.44% for IBB, or $8 to $44 per $10,000 a year.
- The 2 biotech funds had median volatility of 22.4%, 1.5 times the 14.7% of the 4 broad funds.
- XBI fell 56.7% from peak to trough (month-end prices; lows within a month are not captured), against 23.9% for SPY.
- XLV paid the highest trailing yield at 1.53%, while IBB paid 0.17%.
Which health care ETFs performed best?
XBI led the group over one year at 54.5% with dividends reinvested, and IBB followed at 42.2%. Over five years the order changed: XLV ranked first at 7.2% a year, and XBI ranked last at 4.3%. The one-year leader is not the five-year leader, so recent leadership does not carry back through the longer record.
1. One-year gap: 33.3 percentage points
XBI returned 54.5% over the past year and IYH returned 21.2% (WealthyBud data · 6 health care funds, total return · October 2, 2026). All 6 funds have 121 month-end prices, so none is excluded from the multi-year comparisons below.
2. XBI led the three-year run at 28.5% a year
XBI compounded at 28.5% a year over three years, ahead of IBB at 19.1%. IYH came last at 10.5%, a spread of 18.0 points (WealthyBud data · 3-yr annualized total return · October 2, 2026).
3. Five-year spread: 2.9 points a year
XLV returned 7.2% a year and XBI returned 4.3% a year. The 4 broad funds sit within 1.1 points of each other (6.1% to 7.2%) (WealthyBud data · 5-yr annualized total return · October 2, 2026).
4. BLS expects healthcare jobs to grow much faster than average
The Bureau of Labor Statistics says overall employment in healthcare occupations is projected to grow much faster than the average for all occupations from 2025 to 2035, with about 1.9 million openings a year on average, per the BLS Occupational Outlook Handbook. That is a demand backdrop, not a forecast for fund returns.
| Ticker | Fund | Expense ratio | 1-yr total return | 5-yr total return (ann.) | Volatility (ann.) | Trailing yield |
|---|---|---|---|---|---|---|
| FHLC | Fidelity MSCI Health Care Index ETF | 0.084% | 22.0% | 6.1% | 14.7% | 1.26% |
| IBB | iShares Biotechnology ETF | 0.44% | 42.2% | 5.2% | 18.8% | 0.17% |
| IYH | iShares U.S. Healthcare ETF | 0.37% | 21.2% | 6.2% | 14.7% | 1.13% |
| VHT | Vanguard Health Care ETF | 0.09% | 22.0% | 6.3% | 14.7% | 1.48% |
| XBI | State Street SPDR S&P Biotech ETF | 0.35% | 54.5% | 4.3% | 26.0% | 0.35% |
| XLV | State Street Health Care Select Sector SPDR ETF | 0.08% | 21.3% | 7.2% | 14.8% | 1.53% |
| SPY | State Street SPDR S&P 500 ETF Trust | 0.0945% | 16.7% | 13.9% | 15.7% | 0.99% |
How much do health care ETFs cost?
Expense ratios range from 0.08% for XLV to 0.44% for IBB, with a median of 0.22%. On $10,000 that is $8 to $44 a year. The S&P 500 fund SPY charges 0.0945%. The biotech funds’ median ratio is 0.395% against 0.087% for the broad funds.
5. XLV costs 0.08% and IBB costs 0.44%
The cheapest health care fund is XLV, followed by FHLC at 0.084% and VHT at 0.09%. The most expensive is IBB, a 5.5-fold difference (WealthyBud data · issuer-verified expense ratios · October 2, 2026).
6. State Street lists a 0.08% gross expense ratio for XLV
The fund page says the gross expense ratio is 0.08%, meaning before any fee waivers, and lists $42.73 billion in assets as of October 1, 2026, per the State Street XLV page. XBI holds $10.08 billion per its page, and IBB holds $10.87 billion per its iShares page.
Compare major ETFs by fees and returns
How volatile are health care ETFs?
XBI was the most volatile health care fund, with annualized volatility of 26.0%, against 14.7% for IYH, VHT, and FHLC (tied). XBI had the deepest drawdown at 56.7%, and VHT the shallowest at 15.2% (month-end prices; lows within a month are not captured). Volatility measures monthly swings; drawdown measures the worst fall.
7. XBI swung most: 26.0% annualized
XBI had the highest volatility, followed by IBB at 18.8%. Volatility is the annualized standard deviation of the last 60 complete monthly returns through September 30, 2026 (WealthyBud data · annualized volatility · October 2, 2026).
8. IYH, VHT, and FHLC tied for least volatile at 14.7%
IYH, VHT, and FHLC tied as the least volatile funds, all at 14.7% to one decimal. The 4 broad funds range from 14.7% to 14.8%, so the spread among them is 0.1 points (WealthyBud data · annualized volatility · October 2, 2026).
9. XBI fell 56.7% peak to trough
XBI had the deepest drawdown, IBB next at 33.6%. The broad funds' falls ranged from 15.2% to 16.3%. Drawdown uses 121 month-end prices from September 30, 2016 to September 30, 2026 plus the October 2, 2026 price; lows within a month are not captured and the dataset does not record when each low occurred. (WealthyBud data · max drawdown · October 2, 2026)
How do health care ETFs compare with the S&P 500?
Over five years, 0 of 6 health care funds beat the S&P 500 fund SPY, which returned 13.9% a year. Over one year 6 beat it, and over three years 1 did. Over ten years 0 did. Results change with the window measured.
10. 0 of 6 funds beat the S&P 500 over five years
SPY returned 13.9% a year. The best health care fund, XLV, returned 7.2%, a gap of 6.7 points. The widest gap was 9.6 points (WealthyBud data · 5-yr annualized total return vs SPY · October 2, 2026).
11. 6 of 6 beat the index over one year, 1 over three
SPY returned 16.7% over one year and 23.1% a year over three. XBI, IBB, FHLC, VHT, XLV, and IYH beat it over one year (WealthyBud data · 1- and 3-yr total return vs SPY · October 2, 2026).
12. Ten-year record: XLV and VHT tied at 10.5% a year vs 15.3% for SPY
Over ten years, 0 of 6 health care funds beat the index. XLV and VHT tied for the best at 10.5% a year (to one decimal) and IBB the weakest at 8.1% (WealthyBud data · 10-yr annualized total return; all funds have 121 month-end prices · October 2, 2026).
13. 4 of 6 funds were less volatile than the index
SPY measured 15.7%. XLV, IYH, VHT, and FHLC came in below it, and 2 of 6 funds fell further than 23.9% in drawdown (month-end prices; lows within a month are not captured) (WealthyBud data · volatility and drawdown vs SPY · October 2, 2026).
How do biotech ETFs compare with broad health care ETFs?
The 2 biotech funds had median volatility of 22.4%, 1.5 times the 14.7% of the 4 broad funds. Their median worst drawdown was 45.1% versus 15.5% (month-end prices; lows within a month are not captured). Over one year biotech returned a median 48.4%, ahead of the broad funds’ 21.6%. Five-year returns were 4.7% and 6.3%.
14. Biotech was 1.5 times as volatile as broad health care
XBI and IBB had volatility of 26.0% and 18.8%; XLV, VHT, IYH and FHLC sat between 14.7% and 14.8% (WealthyBud data · medians by fund type · October 2, 2026).
15. Biotech drawdowns were 2.9 times as deep
XBI fell 56.7% at its worst and IBB fell 33.6% (month-end prices; lows within a month are not captured). The broad funds' median fall was 15.5% (WealthyBud data · max drawdown, medians by fund type · October 2, 2026).
16. Median biotech return was 48.4% over one year versus 21.6% for broad funds
Median one-year returns were 48.4% for biotech and 21.6% for broad funds; three-year 23.8% and 11.1% a year; five-year 4.7% and 6.3% a year (WealthyBud data · medians by fund type, dividends reinvested · October 2, 2026). Two funds per group is a small sample, so read these as descriptions, not rules.
17. FDA's drug center approved 46 novel drugs in 2025 and 50 in 2024
The FDA says CDER approved 46 new drugs never before approved or marketed in the U.S. in 2025, per its 2025 novel approvals page, and 50 in 2024, per its 2024 page. Approvals are one input for biotech companies, and XBI tracks a modified equal-weighted index of them, per its State Street page.
| Group | Expense ratio | 1-yr return | 3-yr return (ann.) | 5-yr return (ann.) | Volatility | Worst drawdown (month-end) |
|---|---|---|---|---|---|---|
| Biotech (IBB and XBI) | 0.395% | 48.4% | 23.8% | 4.7% | 22.4% | 45.1% |
| Broad health care (FHLC, IYH, VHT, and XLV) | 0.087% | 21.6% | 11.1% | 6.3% | 14.7% | 15.5% |
What do health care ETFs pay?
XLV paid the highest trailing yield at 1.53%, and IBB paid the lowest at 0.17%. The S&P 500 fund SPY yielded 0.99%. Trailing yield divides the last 12 months of dividends by the current price. The 2 biotech funds paid a median 0.26%, against 1.37% for the 4 broad funds.
18. XLV yields 1.53%; IBB yields 0.17%
A $10,000 position in XLV paid about $153 over the last 12 months, against about $17 for IBB (WealthyBud data · trailing-12-month distributions · October 2, 2026).
19. Broad funds paid a median 1.37%, biotech 0.26%
4 of 6 funds out-yield SPY at 0.99%: XLV, VHT, FHLC, and IYH (WealthyBud data · trailing yield vs SPY · October 2, 2026).
What this means for investors
Pick broad or biotech first, then compare fees. The 4 broad funds returned similar amounts and carried similar risk, so a cheaper fund such as XLV at 0.08% saves money without changing the exposure. Biotech is a separate bet with 1.5 times the volatility.
Size biotech for the drop. XBI fell 56.7% at its worst (month-end prices; lows within a month are not captured). Hold only the amount you can leave alone through a fall of that size.
Check your overlap. XLV is also one of the funds covered in our sector ETF statistics, and many S&P 500 funds already hold health care. For company-level data, see health care stock statistics.
Past returns are not forecasts. Leadership rotates, and the figures above describe history only.
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