OBJECTIVES: To examine the economic burden and healthcare utilizations of the hepatitis C virus (HCV) in the U.S. veteran population. METHODS: A retrospective database analysis was performed using the Veterans Health Administration Medical SAS datasets 01OCT2008-30SEP2012). Patients diagnosed with HCV (International Classification of Disease 9th Revision Clinical Modification [ICD-9-CM] codes 070.41, 070.44, 070.51, 070.54, v02.62) were identified, and the first diagnosis date served as the index date. A comparator group was created by identifying patients without HCV but with the same age, region, gender and index year, and matching them by baseline Charlson Comorbidity Index. The index date for the comparator group was randomly chosen to reduce selection bias. A 1-year continuous health plan enrollment period pre- and post-index date was required for both groups. One-to-one propensity score matching (PSM) was used to compare healthcare costs and utilizations during the follow-up period between the HCV and comparison groups, adjusting for baseline demographic and clinical characteristics. RESULTS: Eligible patients (N=270,752) were identified for the HCV and comparison cohorts. After applying 1:1 PSM matching, a total of 107,953 patients were matched from each group and baseline characteristics were well-balanced. HCV patients were more likely to be hospitalized (15.90% vs. 3.19%, p<0.01) and report more emergency room (20.36% vs. 8.17%, p<0.01), physician office (99.18% vs. 61.06%, p<0.01), outpatient (99.25% vs. 61.84%, p<0.01) and pharmacy visits (91.11% vs. 63.13%, p<0.01) which resulted in higher healthcare costs for inpatient ($5,284 vs. $911, p<0.01), emergency room ($237 vs.$76, p<0.01), outpatient ($4,673 vs. $1,760, p<0.01), physician office ($4,247 vs. $1,560, p<0.01), pharmacy ($889 vs. $460, p<0.01) and total costs ($10,846 vs. $3,131, p<0.01) for HCV patients relative to the comparison group. CONCLUSIONS: Patients diagnosed with HCV were more likely to report higher healthcare utilization and were associated with a higher economic burden compared to the matched controls.