OBJECTIVES: HCV infection in Egypt is  one of the highest in the World. The objective of the study is to support Egyptian decision makers by comparing different treatment rates with the recent approved Hep C antiviral agents, and its implications on prevalence progress and associated costs.  METHODS: The analysis was based on a 17-year Markov model.Patients would progress through the various HCV stages from F0 to F3 followed by cirrhosis. Following cirrhosis to other progressive stages up to hepatocellular carcinoma and liver related death. Patients could be cured spontaneously in state F0 or as a result of antiviral therapy in any state from F0 to cirrhosis at a cure rate of 92% in stages F0-F3 and a cure rate of 80% in the stage of cirrhosis. Cured patients would transition to the mortality risk of the age-matched general population. In each cycle, new incident patients were also introduced at a rate of approximately 128,000 or 2%.  RESULTS: Treating 8% of the infected cases each year (450K viremic cases/year) would bring the prevalence to 1 million by 2030. A treatment rate of 1% (65Kcases/yr) or 5% (300Kcases/yr) would bring the prevalence to 5.5 million and 2.5 million respectively by 2030. Total annual costs would start at $1.3Billion in the first year of treatment for the 8% treatment rate but would decrease to $580million/yr by 2030. The 5% and 1% rates would start at $900million & $550million. CONCLUSIONS: A treatment rate of 450Kcases/yr would bring the prevalence to 1 million by 2030. Costs would be significantly high during the first 5 years, but eventually would dop as the disease burden decreases. Alternative scenarios wouldn't eliminate the disease by 2030. A screening policy need to be in place & health infrastructure assessed in preparation for the rising numbers of patients receiving treatment