OBJECTIVES: Examine the economic burden and health care utilizations of the chronic hepatitis C (CHC) in the U.S. veteran population.  METHODS: A retrospective database analysis was performed using the U.S. Veterans Health Administration Medical SAS datasets (01OCT2007-30SEP2012). Patients diagnosed with CHC (International Classification of Disease 9^thRevision Clinical Modification [ICD-9-CM] codes 070.44, 070.54, 070.70, 070.71) were identified, and the first diagnosis date served as the index date. A comparator group was created by identifying patients without a CHC diagnosis but of the same age, region, gender and index year, and matched according to baseline Charlson Comorbidity Index scores. The index date for the comparator group was randomly chosen to reduce selection bias. A 1-year continuous enrollment period pre- and post-index date was required for both groups. One-to-one propensity score matching (PSM) was used to compare health care costs and utilizations during the follow-up period between the cohorts, adjusting for baseline demographic and clinical characteristics.  RESULTS: Eligible patients (N=87,837) were identified for the CHC and comparison cohorts. After applying 1:1 PSM, a total of 69,809 patients were matched from each group and baseline characteristics were well-balanced. CHC patients were more likely to be hospitalized (33.47% vs. 2.42%, p<0.0001) and had more emergency room (ER) (28.55% vs. 6.68%, p<0.0001), physician office (98.65% vs. 53.56%, p<0.0001), outpatient (98.81% vs. 54.46%, p<0.0001) and pharmacy visits (88.73% vs. 57.18%, p<0.0001), resulting in higher health care costs for inpatient ($11,303 vs. $691, p<0.0001), ER ($345 vs. $60, p<0.0001), outpatient ($5,540 vs. $1,382, p<0.0001), physician office ($4,956 vs. $1,230, p<0.0001), pharmacy ($947 vs. $433, p<0.0001) and total costs ($17,789 vs. $2,506, p<0.0001) for CHC patients, relative to comparison patients.  CONCLUSIONS: U.S. veterans diagnosed with CHC were more likely to have higher health care resource utilization and were associated with a higher economic burden compared to matched controls.