OBJECTIVES Sovaldi (sofosbuvir) is the first nucleotide polymerase inhibitor with pan-genotypic activity and a high barrier to resistance. Efficacy of sofosbuvir-based regimens demonstrated >90% SVR  across genotype (GT) 1-6 in five phase III clinical trials of sofosbuvir administered with ribavirin or a combination of pegylated interferon alfa and ribavirin (PR). Sofosbuvir is also the first all-oral 24-week option available for patients unsuitable for interferon (UI). This analysis evaluated the cost-effectiveness and long-term outcomes of sofosbuvir in Swedish treatment-naïve genotype GT1/4/5/6 patients and GT2 and 3 patients who are treatment-naïve, treatment-experienced, interferon eligible (IE) and UI. METHODS A Markov-model followed 10,000 patients for a lifetime, with 20% initiating treatment at the compensated cirrhotic stage. For patients IE SOF/PR for 12 weeks was compared to telaprevir, boceprevir and PR, showing the highest SVR rates and a favourable safety profile. A societal perspective was adopted by considering productivity losses associated with treatment and advanced liver disease (ALD). RESULTS Sofosbuvir regimens, including interferon-free, were shown to be cost-saving across all genotypes and against all current treatment alternatives in Sweden. In GT1, this novel therapy incurs approximately 42%, 31% and 25% lower costs than PR, boceprevir and telaprevir, respectively. Sofosbuvir also reduces the burden of HCV. In 10,000 patients, we estimated that on average 1697, 1417, 607 and 204 cases of compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma and liver transplant, respectively, and 92 deaths could be avoided with sofosbuvir-based regimens compared with telaprevir, boceprevir, PR and no treatment. CONCLUSIONS Cost-effectiveness analysis based on a Swedish societal perspective (i.e. including productivity losses due to treatment and ALD) shows sofosbuvir-based treatments to be cost saving in all genotypes and against all current treatment alternatives. In order to optimally allocate scarce societal resources, arguably all costs related to HCV treatment need to be included in the cost-effectiveness analysis.