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Introduction : Hemophilia is a very expensive disease. Ameliorations in the management of hemophilia cause increased patient survival, more complex disease management, and augmented treatment costs. A literature search related to the cost of hemophilia was analyzed. Areas covered : Clotting factor concentrates, which are the keystone of management, are costly. In fact, the yearly expenditure in the USA is 250,000 USD per adult patient. Indirect expenses also play a part in the economic load, and include lost productive capacity, uncompensated caretaker tariffs, and hemophilia-related physical handicap. Factor concentrates are responsible for more than 90% of the direct health-care expenditures of hemophilia. In an evaluation of the cost of management with high-dose prophylaxis in previously untreated patients from childbirth to puberty, including immune tolerance induction (ITI), the average annual treatment cost (Euros per kilogram) was 4391 EUR (approximately 4865 USD), and the average ITI cost was 383,448 EUR (approximately 424,860 USD). The expected ITI recovery period in the aforementioned evaluation was 1.8 years. To reduce costs, strategies such as disease management programs and drug pricing programs have also been implemented. Expert opinion : Knowing the current cost of hemophilia is essential to ensure that patients are treated as efficiently as possible.