OBJECTIVES: There are approximately 4 million of Hepatitis C Virus (HCV) carriers in Europe. HCV infection is a leading cause of liver cirrhosis (LC), transplantation (LT), and hepatocellular carcinoma (HCC). On the brink of new antiviral treatments in France, we aimed at evaluating the 2009 hospital costs related to chronic hepatitis C. METHODS: All hospital stays with a B18.2 ICD-code were extracted from the 2009 hospital database and distributed in five groups: uncomplicated chronic hepatitis C, LC, HCC, LT, and unclassifiable. Costs were calculated using the French medical information system (PMSI). RESULTS: A total of 27,258 stays were identified (15,482 patients): uncomplicated hepatitis C (42%), LC (41%), HCC (13%), LT (2%), unclassifiable (2%). Mean length of stay was 6.1  and 28.7 days in medical and surgical units respectively; 8,214 medical procedures for baseline/follow-up assessments were carried out in patients with uncomplicated hepatitis, including 1,970 liver biopsies. Annual cost was estimated at 65,652,651€, including 47% for LC, 18% for HCC, and 19% for LT. The mean annual cost per patient increased from 1,049€ (uncomplicated hepatitis) to 4,748€ for LC, 6,513€ for HCC, and 40,152€ for LT (expensive drugs excluded).  Expensive drugs accounted for 7% of total costs in public sector (95% of all stays), including 30% for cancer therapies, 33% for erythropoietins, 12% for anti-infection drugs and 11% for hemostasis. CONCLUSIONS: This first analysis devoted to HCV infection of the French hospital national database brings new and essential information. It shows that 84% of HCV-related hospital costs are attributable to advanced liver diseases, and 19% to the 2% of patients’ recipients of a liver transplant. Together with more efficient therapies, enhancing screening and access to treatment policy could substantially relieve the social burden of HCV.