OBJECTIVES: In Brazil it is estimated that there are more than 3 million patients chronically infected with HCV, making this disease a major public health problem. HCVI leads to chronic liver disease states such as cirrhosis and the need for transplantation. There is little published data on the cost of HCVI in Brazil. The aim of this study is to investigate medical resource use and direct treatment costs for each state of HCV infection from the perspective of the private medicine payers in Brazil. METHODS: Three Delphi panels were performed, one with hepatologists, one with intensivists and another with oncologists in order to delineate practice patterns and to obtain resource utilization for routine treatment and monitoring, adverse event management and other clinical parameters representative of community physicians management of HCV infection.Responses were obtained from six hepatologists, six intensivists and six oncologists from various centers in Brazil with experience of treating HCVI. RESULTS: The expected annual costs per each disease stage, not treated with antiviral medication, per patient were: R$1.069 for mild chronic hepatitis, R$1,277.00 for moderate chronic hepatitis, R$1,522.00 for compensated cirrhosis, R$15,932.00 for ascites, R$31,352.00 for refractory ascites, R$21,427.00 for variceal hemorrhage, R$106,922.00 for hepatic encephalopathy, R$20,884.00 for hepatocellular carcinoma, R$136,900.00 for liver transplantation, R$10,540.00 liver transplantation after the first year and R$789.00 for remission. CONCLUSIONS: These cost data can be used to model disease burden in Brazil. The costs increase dramatically in the more advanced disease health states. Probably, slowing the progression to these disease states may be cost saving. One USD = 2.57 Brazilian Reais at the moment of the study.