OBJECTIVES: In the United States, chronic hepatitis C (HCV) is responsible for more death and disease than HIV/AIDS. It is the most common chronic blood-borne infection, and remains a major cause of death and illness in the United States. Current standard of care treatments for HCV have difficult dosing regimens and are often accompanied by undesirable side effects. With a host of new clinically promising, interferon-free, combo therapies currently in clinical trials it is important to assess the cost-effectiveness of the current and future treatment options for chronic hepatitis C. The objective of the current study is to assess the cost-effectiveness of current, and future, treatment options for treatment naïve genotype 1 chronic hepatitis c patients. METHODS: Cost-effectiveness analysis using a Markov model of the natural disease progression of HCV infection and impact of treatment. We use a simulated 20 year model of a hypothetical cohort of 1000 treatment naïve genotype 1 HCV patients to assess the cost-effectiveness of no treatment, boceprevir + pegylated interferon + ribavirin (BOC+P+R), telaprevir + pegylated interferon + ribavirin (TVR+P+R), and sofosbuvir + ledipasvir + ribavirin (SOF+LVR+R). RESULTS: Over the 20 year time horizon of this cohort no treatment would result in 9.76 QALYs and a total discounted cost of $41,434, while BOC+P+R resulted in 11.06 and $132,070, TVR+P+R in 11.08 and $132,482, and SOF+LVR+R in 11.90 and $172,384, respectively. Our analysis showed that BOC+P+R and TVR+P+R were weakly dominated, while SOF+LVR+R was the most cost-effective therapy. CONCLUSIONS: The interferon-free combo therapy SOF+LVR+R is the most cost-effective treatment option, with an ICER of $61,291 when compared to no treatment. These results have important economic, and policy implications for the treatment of chronic hepatitis C.