OBJECTIVES: To quantify liver transplant risk and mean total costs in treated versus untreated patients diagnosed with hepatitis C virus (HCV). METHODS: The sample included individuals with commercial or Medicare Advantage insurance, aged 19-89, with ≥1 HCV diagnosis or HCV treatment prescription claim between 1/1/2008 and 6/30/2013, excluding those diagnosed with hepatitis B. Patients were observed during their full post-index enrollment following date of transplant or first HCV diagnosis or prescription. Cox proportional-hazard regression approximated adjusted relative risk (aRR) of transplant in treated versus untreated individuals, controlling for age, gender, geographic location, Deyo-Charlson Comorbidity Index, RxRisk-V Score, and pre-index medical and pharmacy costs. Results were also generated by treatment adherence level based on proportion of days covered (≥80%, 50-79%, <50%). Mean total costs (plan- and patient-paid) were assessed over the observation period using generalized linear models with log link and gamma distribution. RESULTS: CONCLUSIONS: Despite adjusting for covariates, there was no evidence that HCV treatment reduced risk of liver transplant, suggesting that treated patients may be sicker and have unmeasured confounders. However, within the treated group, there was no change in risk of transplant by level of adherence, underscoring the need for further evidence on liver transplant outcomes.