OBJECTIVES:  To evaluate the cost-effectiveness and the budget impact of introducing oral direct-acting antivirals (DAAs) to the hospital formulary in Hong Kong.  METHODS: We developed a decision analytic model to compare short-term costs and health outcomes of chronic HCV genotype 1 infection in Hong Kong patients on the current standard treatment (triple therapy of pegylated interferon, ribavirin and boceprevir) to new treatments (sofosbuvir, ledipasvir/sofosbuvir or ombitasvir/paritaprevir/ritonavir and dasabuvir). Costs, sustained viral response (SVR) and incremental cost-effectiveness ratio (ICER) defined as incremental cost per treatment success were estimated for the cost-effectiveness evaluation. Five-year healthcare expenditures before and after the introduction of new treatments were compared to assess the budget impact to the public healthcare system. RESULTS:  Medication costs accounted for >85% of overall treatment costs for all treatments. Compared to the current standard treatment, new treatments improved the SVR from 59-66% to 82.3-99.8% upon patient treatment history and cirrhosis conditions. New treatments mainly dominated current treatment as cost-saving options given their greater effectiveness and lower costs with ICERs ranged from -$3,395 to -$43,643 per treatment success. Introducing new treatments associated with 16.5% ($99.2 million) budget increase on HCV management over five years. A 50% change in medication costs reflected a change in budget ranging from -$229.2 to $426.5 million. CONCLUSIONS: New HCV treatments are cost-effective alternatives to current standard care in Hong Kong. Introducing the new treatments to the public hospital formulary yields moderate budget increase in five years.