OBJECTIVES: To document variations in resource utilization and costs by disease severity, sustained viral response (SVR), and genotype in a European population with chronic hepatitis C virus (C-HCV).  METHODS: Patient charts from the United Kingdom, France, Germany, Spain, and Italy were retrospectively reviewed. Inclusion criteria were: C-HCV diagnosis within past 5 years; age ≥18 years; no diagnoses of hepatitis B or HIV/AIDS; ≥1 year follow-up post-diagnosis; no clinical trial participation. All-cause utilization and costs (2009 €) for hospitalizations, emergency room (ER) and office visits, and specialty referrals were aggregated within patients over 1 year post-diagnosis. C-HCV severity was assessed via Metavir score. Among patients receiving C-HCV-directed pharmacotherapy, SVR was defined by viral RNA <10 IU/mL at ≥6 months post-treatment. Utilization and cost differences across clinical factors were assessed with multivariate modeling. RESULTS: In total, 1016 patients were identified. Overall, 23% of severe patients were hospitalized versus 2.5% of mild. Hospitalization was 5 times more likely in severe C-HCV compared to mild (odds ratio [OR]=5.39; P=0.008), while the hospitalization rate, measured by Poisson incidence rate ratio (IRR), was 4 times higher (IRR=3.98; P=0.010). Hospital costs were €1380 higher in severe versus mild disease (P=0.001). Hospitalization risk in SVR attainers was less than half that of non-attainers (OR=0.22; P<0.0001). ER, office, and specialist visit rates were significantly lower among SVR attainers. Genotype had little effect on utilization, but genotype 1 was associated with slightly lower (€90 per patient; P<0.0001) hospital costs versus genotypes ≥2. CONCLUSIONS: Disease severity and SVR are important predictors of C-HCV costs. Awareness of these factors by public health systems, which bear the high cost burden of C-HCV, may help promote strategies for earlier disease detection and increased treatment initiation before progression occurs, as well as formulary access for more convenient therapies that increase treatment persistence and thereby SVR rates.