A comprehensive measurement of hemophilia economic burden in Iraq: a field-based study.

Abstract

Background: This study assessed the economic burden of hemophilia A, B, and A with inhibitors, including direct medical, non-medical, and indirect costs from both governmental and patient perspectives.

Research design and methods: A retrospective cost-of-illness analysis was conducted at a public hospital in Baghdad, Iraq serving hemophilia patients. Government costs were derived from medical records, while patient out-of-pocket expenses were gathered via interviews. Data were collected from November 2024 to March 2025. One-way ANOVA tested cost differences across hemophilia types and severity levels.

Results: The Ministry of Health spent US$11.30 million annually on 446 hemophilia patients (average $25,312 per patient), with clotting-factor replacement comprising 70.6% of the costs. On-demand treatment accounted for 84.5% of the hospitalization expenses. Patients with hemophilia-A-with-inhibitors incurred the highest annual cost ($113,651), followed by hemophilia-B and hemophilia-A-without-inhibitors cases. Severe cases and comorbidities like hepatitis C further increased spending. Non-medical costs averaged $440.33, and indirect costs $281.42 per patient. School absenteeism totaled 1,753 days across 144 students, averaging 12.2 days each.

Conclusion: Clotting-factor replacement remains the primary cost driver in hemophilia care, with inhibitors significantly increasing expenditures. Non-medical and indirect costs add to the overall burden, underscoring the need for prophylaxis and access to innovative therapies.