Objective: To determine the Hemophilia A (HA) treatment (pdFVIII or rFVIII) with the lowest cost per quality-adjusted life-year (QALY) in Mexico. Methods: A cost-utility study was conducted, with an institutional perspective, in two time horizons, 30 and 50 years. The discounting rate was three percent for costs and benefits. The source of information was a meta-analysis of the international literature validated by Mexican hematologists using the Delphi technique. A decision tree with Bayesian approach and a Markov chain considering the probabilities of getting infected with Hepatitis C Virus (HCV) and Immunodeficiency Virus (HIV) because of the use of a Factor VIII concentrate and the availability of the products were performed, we also included the probabilities of HCV and HIV infections due to the use of cryoprecipitates because of the lack of the treatments analysed. The model included the states of health: HA without infection, HA+HCV, HA+HIV, HA+HIV+HCV and death. Due to lack of published information and low incidence observed, the probability of getting infected with an emergent disease (Creutzfeld-Jakob, SARS) due to the use of FVIII treatment was not included. The results were evaluated with incremental analysis and net benefits varying the incidence of HIV and HCV and the availability of the products. The sensitivity analysis was one-way, two-way and probabilistic (acceptability curves and net benefits). Results: Patients using rFVIII get more benefits with the lowest cost per QALY when comparing to pdFVIII treatment (30 years-analysis: rFVIII=16.45 QALY and USD$50,673/QALY, pdFVIII=11.05 QALY and USD$51,950/QALY, ICER USD$48,066; 50 years-analysis: rFVIII=20.79 QALY and USD$51,406/QALY, pdFVIII=12.23 QALY and USD$60,765/QALY, ICER USD$38,042). The sensitivity analysis varying the incidence of HIV and HCV showed the robustness of the base study. Conclusion: Recombinant Factor VIII is a cost-effective option in the treatment of patients with hemophilia A in Mexico.