OBJECTIVES: Treatment of chronic hepatitis C infection is well established and will be expanded to triple treatment with new drugs like hepatitis C virus (HCV) protease inhibitors in Germany in fall 2011. Costs related to the current HCV guidelines will be a basis for further health economic analyses needed for pricing strategies but are not available yet. The aim of this study is to analyse the costs associated with diagnosis, treatment and monitoring of HCV infected patients according to the 2010 German S3-consensus guideline considering HCV genotype and length of therapy. METHODS: Patients with chronic HCV infection were divided in patients with 1) normal transaminases; 2) elevated transaminases; 3) compensated cirrhosis; and 4) decompensated cirrhosis. Direct costs according to the actual 2010 HCV German guideline were analysed for basic diagnostic procedures, monitoring and treatment for patient groups 1-3. Costs were modelled according to treatment duration (16 to 72 weeks) depending on the sustained viral response and HCV genotype. Costs were calculated according to the German outpatient fee scale EBM-2010. RESULTS: Costs for basic diagnostics including determination of HCV genotype and diagnosis of potential hepatic comorbidities accounted for €401 per patient. Monitoring costs accounted for €596 – €1173 depending on length of therapy. Pharmaceutical costs accounted for the largest part of the costs (€7,709 – €34,692). The total costs of a 16-week treatment including basic diagnostics, monitoring and pharmaceutical costs accounted for €8,706, €12,734 for a 24-week treatment, €24,529 for a 48-week treatment and €36,266 for 72-week treatment. CONCLUSIONS: State of the art and guideline cost evaluation for treatment of HCV infection show high costs for optimal and viral response guided therapy. These data can be used for further investigation of real life costs and costs of new triple treatment strategies in HCV treatment.