OBJECTIVES: As evidenced in REALIZE study, sustained virologic response (SVR) rate increased from the 17% to 63% in treatment-experienced (TE) chronic hepatitis C (CHC) patients, when telaprevir (TVR) was added to standard of care. In this cost-effectiveness model, PR is compared with TVR triple therapy (with response guided treatment approach) in TE CHC patients. METHODS: In this cost-effectiveness model, TVR+PR is compared with PR. Analysis population includes TE and unresponsive or failed patients infected with genotype 1 HCV. Progression of CHC is simulated by a Markov model with 1-year duration of cycles within life-time horizon. The source of clinical inputs is REALIZE study, in which TE CHC patients had been randomized to TVR+PR or PR. The sources of economic inputs are the drug price list (National Ministry of Health, June 2014) and procedure price list (National Institution of Security, April 2014). The analysis was performed from the point of view of the governmental payer, with direct costs only. The discount rate was set at 2%, national GDP per capita: 8.009€, year 2013, currency rate: 2.80 TL/Euro. RESULTS: Total costs of strategies (medications and other components) were 29.735€, 28.938€ and 28.343€, for TVR, P2aR and P2bR, respectively. QALYs gained was 1.25 years with TVR+PR with extra costs of 797€ and 1.393€ (vs P2aR and P2bR, respectively). Corresponding ICER values were 640€/QALY and 1.118€/QALY for TVR+PR vs P2aR and TVR+PR vs P2bR, respectively. Thus, TVR was definitely cost-effective. CONCLUSIONS: Although the initial cost of treatment with TVR is higher than PR, in CHC patients, the cost savings that will be realized with the very successful clinical prognosis make treatment with TVR clearly very cost-effective and close to cost neutral. Therefore, all TE CHC patients who not responded or failed after a response, should be considered as a candidate of TVR treatment.