Recombinant factor VIII in hemophilia A: the Canadian experience

Programs that provide health care for people with inherited bleeding disorders should strive to ensure that all patients have equal access to the safest and most efficacious replacement products. The widespread introduction of very high purity, plasma-derived and recombinant factor concentrates for use in the Canadian hemophilia population in October 1993 is consistent with this goal. The data from Canada are reassuring in that the prevalence of inhibitors has not increased significantly in a large number of severe hemophilia A patients switched to recombinant factor VIII concentrate, and that no cases of therapy-associated thromboses have been reported with hemophilia B patients switched to high purity factor IX concentrates. However, high-purity factor concentrates are very expensive. In Canada, funding for health care is a government-based responsibility. In other countries where funding for health care is organized differently, other treatment recommendations may be more appropriate.