OBJECTIVES: To estimate the cost-effectiveness in Romanian setting of triple therapy with Telaprevir and Peginterferon/Ribavirin (TVR+PR) compared with PR alone in previously untreated patients with hepatitis C virus (HCV) infection from the third payer - National Health Insurance Agency (NHIA). METHODS: We used the published data of efficacy from large international trials and published  Markov models to estimate the cost-effectiveness of this new HCV serine protease inhibitor  (telaprevir) using the specific local cost and epidemiological data. The superior results shown by Jacobson IM et all in ADVANCE trial - (Telaprevir for previously untreated chronic hepatitis C virus infection) for telaprevir - 75% sustained virologic response compared with 44% for PR alone. The discount rate was 3% for both cost and efficacy. Cost were extracted from NIHA tarrifs, Minister of Health drugs price catalog and from previous published data.  The reference patient was a 45-year-old male with chronic liver disease due to chronic HCV infection. Time horizon was set patient life time. The clinical outcomes and Utilities for all health states were taken from ADVANCE phase-3 trial. The comparator was Peginterferon 2alfa with ribavirin. The effectiveness was measured in quality-adjusted life years (QALY).The cost of secondary drug reactions were not included in the model. RESULTS: Incremental cost effectiveness ratio (ICER) for telaprevir in combination with PR compared to PR alone was 23291 €/1 gained QALY. CONCLUSIONS: As in Romania HTA is only at the beginning, health authorities has to evaluate the most cost-effective strategy to follow for treatment of patients with chronic hepatitis as ICER of telaprevir in combination with PR compared with PR alone is reaching or is above the level recommended by Word Health Organisation as upper threshold (3 GDP/capita – Romania’s GDP/capita is 6200Euro). Further CUA should be performed, including for guided therapy and treatment designated to previous treated patients.