OBJECTIVES: Recent advances in the management of hepatitis C virus (HCV) have yielded therapeutic modalities that are more efficacious, better tolerated, and have a lower pill and injection burden. Given the large population affected by HCV, decisions by health technology assessment (HTA) bodies weigh significantly in terms of societal benefits and expenditures. The objective of this analysis was to evaluate recent patterns in HCV-related HTA decisions in selected countries. METHODS: HTA surveillance was conducted for Australia, Canada, France, Germany, and the United Kingdom (UK) from January 1, 2012 to June 1, 2015 (42 months). HTAs for HCV treatments were evaluated by genotype, decision, and decision rationale. Decisions were categorized as favorable, unfavorable, mixed (both favorable and unfavorable), and neutral (deferral).  RESULTS: CONCLUSIONS: Based on the last 42 months of HCV-related HTAs, 75% of decisions were favorable. However, the most significant factors leading to unfavorable assessments for HCV products are related to the inability to supply advantageous clinical and cost-effectiveness data. This analysis suggests that manufacturers would have greater success with HTA decisions if more robust health economic and clinical data are generated.