OBJECTIVES:  Evaluate treatment patterns, healthcare utilization and costs of chronic hepatitis C (CHC) patients receiving direct-acting antiviral (DAA) protease inhibitors.  METHODS: Adult patients with ≥1 claim for CHC (ICD-9-CM codes 070.44, 070.54, 070.70, 070.71) and a fill of boceprevir or telaprevir were selected from a de-identified US-based claims database (2006-2012). The date of the first fill for a DAA after 5/13/2011 (date of first DAA availability) was defined as the index date; patients were categorized into either the telaprevir or boceprevir cohorts. Patients had continuous eligibility and no claims for hepatitis B during the 6-months before (baseline) and 12-months following (study period) the index date. Baseline characteristics and study period treatment patterns, healthcare utilization and costs were described. Adjusted study period costs were compared between the DAA cohorts using multivariate analyses.  RESULTS: There were 871 telaprevir and 284 boceprevir patients identified. DAA patients were 54 years old on average and more often male (62%). Approximately 25% of telaprevir and 18% of boceprevir patients had cirrhosis, and 9% of telaprevir and 7% of boceprevir patients had decompensated cirrhosis at baseline. Less than 1% of patients were HIV co-infected. Approximately 54% of telaprevir and 74% of boceprevir patients did not complete minimum recommended therapy (telaprevir: 12 weeks of triple+12 weeks of dual, boceprevir: 4±1 weeks of lead-in+24 weeks of triple). During the study period, over half of patients had anemia (boceprevir: 55%, telaprevir: 54%). Study period healthcare utilization measures were generally similar between the DAA cohorts. Telaprevir patients experienced numerically higher study period unadjusted medical (boceprevir: $16,927, telaprevir: $19,519) and drug costs (boceprevir: $59,953, telaprevir: $76,497) than boceprevir patients; however, after adjusting for baseline characteristics, only drug costs remained significantly different.  CONCLUSIONS: CHC patients receiving telaprevir or boceprevir experienced high rates of early discontinuation and high medical and drug costs.