OBJECTIVES: Individuals infected with hepatitis C (HCV) will transition through a series of disease stages over many years. This study estimates the incremental cost of direct medical care and health outcomes for a cohort of Albertans with HCV. METHODS: The study population was a closed cohort of 1190 persons (mean 50 years) diagnosed with HCV in Alberta in 2012. We used a Markov model with one year cycles and an annual discount rate of 3% to estimate HCV-related costs and health outcomes over 10, 20, and 30 year time horizons. We used a health system perspective with screening and treatment costs included.   Alberta data sources were used when available. Otherwise we used information from the literature.  One-way sensitivity analyses were performed for all key parameters across the three time horizons and different percentages of drug provision (5%, 10% and 15%). RESULTS: For 1190 patients, we expect health system costs of $75 million over a 10-year horizon and $120 and $142 million over 20 and 30 year horizons (2012 CAD$). We estimated 580 deaths over 30 years, of which 52% will be due to HCV. Antiviral treatment will have been received by 1097 patients and 184 will have received a liver transplant. The sensitivity analysis shows that fibrosis stage at diagnosis will have the greatest impact on costs. Other key variables generating costs were liver-related morbidity and transplants.  The need for transplants decreases when antiviral use increases.  This offsets antiviral drug costs. CONCLUSIONS: Our model indicates that the amount of resources required by a single cohort of Albertans is substantial. The model also provides a resource which planners can use to estimate funding, as they will be responsible for allocating the resources needed to treat HCV.