Financial toxicity of hemophilia care in Southeast Asian countries

Hemophilia is a rare, chronic bleeding disorder with high treatment costs that pose significant economic challenges, particularly in many countries of Southeast Asia (SEA), where disease burden is disproportionately high. In this commentary, we explore the drivers of financial toxicity (FT) in hemophilia care across SEA. We identify key contributors including inadequate health insurance coverage, reliance on unstable humanitarian aid, geographic disparities in care access, and cultural factors that place financial and emotional strain on families. Despite some policy efforts-such as universal health coverage and national cancer control plans-systemic gaps in financing, infrastructure, and provider distribution persist. We propose actionable steps using the social ecological model of health to reduce FT at the individual, interpersonal, community, and policy levels, including expanded insurance coverage, decentralized care, telehealth access, financial navigation services, and public education. Addressing the multifactorial nature of FT is essential to improving quality of life and equity in care for patients with hemophilia in SEA.