OBJECTIVES: Hemophilia is a hereditary, lifelong bleeding disorder. Patients are deficient in either coagulation factor VIII (hemophilia A) or IX (hemophilia B). This study is aimed to assess the economic impact of these conditions in Mexico. METHODS: In this cost-of-illness study, both direct medical costs (diagnosis, follow-up,  prophylaxis and on-demand coagulation factor replacement therapy, inpatient and outpatient care of hemorrhages and complications) and indirect costs related with loss of productivity in either adult patients or in parents of affected children along one year were assessed. Local demographic and epidemiological data (last update: 2011), as well as  annual bleeding rates in both prophylaxis and on-demand approaches were extracted from published sources. Resource use patterns were derived mainly from Mexican Clinical Practice Guidelines co-authors (n=8) through a survey. Unitary costs of medical resources were gathered mainly from Instituto Mexicano del Seguro Social (IMSS) sources. It is assumed that productivity losses of adult patients/parents of hemophiliac children are proportional to the number of days in hospital; average per hour wage and worked hours per week were extracted from National Statistics Office database. All costs are expressed in 2013 USD. RESULTS: A total of 3906 (87%) type A and 597 (13%) type B patients comprised the 2011 documented prevalence of hemophilia in Mexico. Most (57%) of all patients received medical care at IMSS. Direct medical costs (79.3 USD millions) and indirect costs (370,398 USD) accounted for 99.5% and 0.5% of total costs (79.7 USD millions), respectively. Among direct medical costs, acquisition of coagulation factors represented the most important category (55.1 USD millions, 69.23%), followed by non-pharmacological care of hemorrhages (20 USD million, 25.12%). Average cost per patient was very similar: 18,152 and 14,662 USD for type A and B, respectively.   CONCLUSIONS: Despite its low prevalence, hemophilia imposes a considerably high economic burden in Mexico´s healthcare system.