OBJECTIVES: The aim of this study was to assess disease stage dependent resource use and costs in chronic genotype 1 hepatitis C (CHC) patients in Belgium. METHODS: The medical records of 157 CHC patients were reviewed to identify medical costs over a follow up period of 3 years. Six disease stages were defined based on histology/clinical data: mild disease (F0-F2), moderate disease (F3) or compensated cirrhosis without varices (F4), compensated cirrhosis with varices (F4), decompensated cirrhosis, hepatocellular carcinoma (HCC) and liver transplantation (LT). Data collected were baseline demographic characteristics, HCV-related data and detailed resource use (hospitalizations, day-clinic visits, surgery/interventions, physician visits, diagnostic tests and drug use). Resource use items were multiplied with unit costs (2010) to calculate costs. The public health care payer’s (HCP) perspective was taken including the health insurance and patient co-payment. RESULTS: Intravenous/intranasal drug use was reported in circa 20% of patients, 63% had co-morbidities at study start. Nineteen patients (12%) died during the study period, whereof 79% attributable to HCV. Average number of hospitalizations during the study period ranged between 0.4 (mild disease) and 5.3 (HCC). Cost of care during the study period ranged from €18,993 for mild disease (in 81% due to HCV drug treatment) to €35,987 for patients with HCC (in 83% due to hospitalization, 11% due to medication and in 6% due to ambulatory care) and €65,120 for patients who underwent a liver transplant (79% hospitalization, 18% medication, 3% ambulatory care). Cost of diagnosis of the disease stage ranged between €790 (F3-F4 without varices) and €4142 (decompensated cirrhosis). CONCLUSIONS: Antiviral treatment is the most important cost driver in mild & moderate disease, but once complications of CHC occur, the associated costs far exceed this cost of antiviral therapy.