OBJECTIVES: To estimate the direct medical costs associated with the use of erythropoietin (EPO) in the treatment of anemia in patients with advanced fibrosis and cirrhosis (METAVIR F3-F4) receiving telaprevir in association with peg-interferon and ribavirin (TVR+PR) in the early access program in Brazil. METHODS: Anemia events and EPO use during TVR therapy were gathered from published results of 97 patients in the early access program (EAP) of TVR in Brazil.  Anemia treatment was assumed to be one vial of erythropoietin (EPO) 40.000U per week. Medication unit costs were gathered from a public (SUS) and private payer perspective in Brazil. Sensitivity analysis was carried out for anemia treatment duration and patients with EPO use.  A sub-analysis was performed to estimate the cost of anemia treatment with boceprevir (BOC+PR) based on data from the phase 3 clinical trials. RESULTS: The cost of EPO during TVR+PR treatment in the EAP /anemic patient was R$ 10.190,04 from a private payer perspective compared to R$ 3.545,06 from a SUS perspective. The average cost of EPO was R$ 4.727,34 /patient from a private payer perspective and R$ 1.644,87 /patient from the SUS perspective. Considering the sensitivity analysis, the total cost of EPO treatment ranged between R$ 382.126,50-R$ 601.212,36 from a private payer perspective compared to R$ 132.960,00-R$ 209.190,40 from a SUS perspective for all patients. Considering EPO use for BOC+PRr, the average anemia treatment cost was R$ 7.851,34 /patient from a private payer perspective and R$ 2.731,86 /patient from a SUS perspective. CONCLUSIONS:  In a real life setting, TVR+PR was associated with EPO use although few patients discontinued treatment. Compared to EPO use in clinical trials, TVR+PR was associated with less EPO costs than BOC+PR in a real life setting such as the Brazilian EAP.