OBJECTIVES:  Estimate the direct cost of hepatitis C in Mexico, from the perspective of the healthcare system for the government employees, and simulate the economic impact of new antivirals. METHODS: We reviewed one hundred clinical records of patients diagnosed with chronic hepatitis C, to know the pattern of resources use at two hospitals of the healthcare system for the government employees, taking into account the disease stages based on the Child-Pugh. The inclusion criterion was patients with chronic HVC unresponsive to treatment or without the double viral therapy. Unit prices and costs of medical inputs were obtained from official sources. Demographic and clinical variables were also recorded in order to do comparisons. Statistical analysis of data was made with the SPSS. Simulation of economic impact of treatment with antivirals was done based on natural history of disease over a ten years horizon. RESULTS: Annual mean costs of disease progression and complications were higher for Child-Pugh C (US$8,739) than B (US$6,319) and A (US$2,430). The estimated cost of one patient in Child-Pugh A stage not responding to peginterferon and ribavirin resulted in US$62,506 taking into account that this patient progress until Child-Pugh C. If the not responding patient could be treated with peginterferon, ribavirin and boceprevir the cost would be US$43,633, while a naive patient would cost US$34,302.  CONCLUSIONS: Hepatitis C imposes a high economic burden to the healthcare system for the government employees. The access of this population of patients to new antivirals would result in savings for the institution as well as increasing health benefits for patients.